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Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study
Abstract
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.
... 1,2 Available studies reveal that ED is highly prevalent worldwide; it affects multiple aspects of wellbeing and can have a serious adverse effect on both the patients and their partners. [3][4][5] Based on the variation in the study methods, cultural differences, and the description of ED, large variations in the prevalence of ED are being identified. 6 The prevalence of ED is anywhere from 35% to 75% in several cross-sectional publications. ...
... [7][8] Notable findings have been published in two landmark articles, the Massachusetts Male Ageing Study (MMAS) from the United States (USA) and the European Male Ageing Study (EMAS) from Europe. 3,9 About 52% had an occurrence of mild to moderate ED in males aged 40-70 years, and this was significantly 126 AMJ, Vol.8, No.2, P.125-135, 2023 https://amj.khcms.edu.krd/ associated with age, health, and emotional condition, as stated by the MMAS. ...
... 33,34 Diabetic males have a nearly threefold increased risk of developing ED when compared to nondiabetics in similar studies and they are also more likely to acquire ED 10 to 15 years before non-diabetics. 3 This study revealed a significant association between hypertension and ED on one side and dyslipidemia and ED on the other side (p=0.02 and 0.017 respectively). Comparable results were found within an Italian study of 555 men 17 1 The level of serum prolactin had no effect on ED (p=0.44), according to this study. ...
Background and Objectives: Erectile dysfunction is a highly prevalent disease. It affects multiple aspects of health and can have a serious adverse effect on both the patients and their partners. Diabetes mellitus is a metabolic disorder associated with many chronic complications including erectile dysfunction. The aim of this study was to find out the prevalence and risk factors of erectile dysfunction in patients with type 2 diabetes mellitus. Patients and Methods: A cross-sectional study had been done on 100 adult male patients with type 2 diabetes mellitus, attending endocrinology outpatient at Erbil Teaching Hospital between June and December 2021, and another 50 age-matched non-diabetic controls. Each one of them underwent detailed history taking, clinical examination, and relevant biochemical study. Results: Sixty-three diabetic patients (63%) had erectile dysfunction compared to 6 nondiabetic subjects (12%). Mild, mild-to-moderate, moderate, and severe erectile dysfunction among these patients were 17 (27%), 21 (33.3%), 16 (25.4%), and 9 (14.3%), respectively. Among diabetics, erectile dysfunction was significantly associated with age, obesity, glycated hemoglobin level, duration of diabetes, presence of hypertension, dyslipidemia, and neuropathy (p= 0.001, 0.005, <0.001, 0.038, 0.02, 0.017 and 0.025 respectively) Conclusion: Erectile dysfunction was significantly more prevalent in patients with type 2 diabetes than in non-diabetic patients. Being older than 50 years old, obesity, glycated hemoglobin level higher than 9, diabetes more than 10 years duration, presence of hypertension, dyslipidemia, and neuropathy were significantly in favor of a higher prevalence of erectile dysfunction in this group.
... The mean erected penile length STT was 12.41 cm (7.5-18), while the mean BTT was 14.28 cm (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The mean circumference at the base of the erected penis of the entire cohort was 11.36 cm (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). ...
... The mean erected penile length STT was 12.41 cm (7.5-18), while the mean BTT was 14.28 cm (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The mean circumference at the base of the erected penis of the entire cohort was 11.36 cm (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). ...
... ED is a major health issue with a high prevalence; it is strongly associated with age and has multiple determinants that all contribute to vascular disease as part of the para-ageing phenomena. 16 Patients are living longer and remaining active later in life, and consequently, they have increased expectations towards their erectile function. It is becoming increasingly incumbent upon health professionals to reduce F I G U R E 5 Graphical representation of testosterone data in the whole cohort. ...
Objective
To investigate the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED).
Methods
Patients who attended our urology clinic complaining of ED for more than 6 months were prospectively enrolled in this study over 1‐year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie's disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile and glycated haemoglobin (HA1c). A penile duplex ultrasound study (PDU) was done for all patients after intracavernosal injection (ICI) with alprostadil. Peak systolic velocity (PSV) and end‐diastolic velocity (EDV) were measured after 15 min. Statistical analysis was done using SPSS.
Results
A total of 440 patients were enrolled in this analysis. The mean age was 48(23–81), and the mean BMI was 30 (18–51). Older patients had lower PSV ( r = −0.361, P = 0.000) and higher EDV ( r = 0.174, P = 0.001), and both correlations were highly statistically significant. Diabetics had lower PSV ( r = −0.318, P = 0.000) and higher EDV ( r = 0.139, P = 0.008), which were also highly statistically significant. Smokers had lower PSV ( r = −0.140, P = 0.008) and higher EDV ( r = 0.178, P = 0.001), which were highly statistically significant. Men with larger penises measured skin to tip had lower EDV ( r = −0.119, P = 0.024), which was less significant. Interestingly, there was neither a significant correlation between BMI and PSV (0.16, P = 0.745) nor a significant correlation between testosterone and PSV (0.029, P = 0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD.
Conclusions
Ageing, tobacco consumption, DM and hypertension seem to have a negative impact on penile haemodynamics, which was statistically significant. In our patients, there was no statistically significant effect on penile haemodynamics in patients with increased BMI, low testosterone or PD or according to the size of the penis.
... Erectile dysfunction (ED) occurs due to a difficulty in initiating and/ or maintaining an erection that allows a satisfactory sexual performance [1]. It is the most studied sexual dysfunction in men, with many epidemiological studies showing a prevalence around 30% and the increase with age [2][3][4][5][6]. ED is an important public health problem due to its prevalence and its impact on the quality of life of males [7]. ...
... This sleep stage is known by trigger nocturnal erection, and when in presence of sleep fragmentation there is an impairment of REM sleep [16]. The association of those events provide a peripheral nerve damage with endothelial dysfunction through reduction of NO production and higher levels of endothelin, which promotes a vasoconstriction instead of penile relaxation during erection process [3,8]. ...
Erectile dysfunction (ED) incidence is higher in patients with obstructive sleep apnea (OSA). Studies have suggested that ED and OSA may activate similar pathways; however, few have investigated the links between their underlying genotypic profiles. Therefore, we conducted an in-silico analysis to test whether ED and OSA share genetic variants of risk and to identify any molecular, cellular and biological interactions between them. Two gene lists were manually curated through a literature review based on a PUBMED search, which resulted in one gene list associated with ED (total of 205 genes) and the other with OSA (total of 2622 genes). Between those gene sets, 35 were common for both lists (Fisher exact test, p-value = 0.027). The Protein–protein interaction (PPI) analysis using the intersect list as input showed that 3 of them had direct interactions (LPL, DGKB and PLCB1). In addition, the biological function of the genes contained in the intersect list suggested that pathways related to lipid metabolism and the neuromuscular junction were commonly found in the genetic basis of ED and OSA. From the shared genes between both conditions, the biological pathways highlighted in this study may serve as preliminary findings for future functional investigations on OSA and ED association.
... Over the past decade, many studies have shown that ED can be regarded as an early sign of CVD (6) (13,14). Risk factors for CVD such as hypertension, dyslipidemia, diabetes, smoking, and obesity are also applicable to ED (15,16). Vascular insu ciency including atherosclerosis and endothelial dysfunction is now considered to be the main pathophysiological mechanism common to ED and CVD (17,18). ...
... In addition, a meaningful long-term follow-up study showed that the prevalence of ED increased with age, from 26 per 1,000 man-years to 46 per 1,000 manyears in men aged 60-69 years (56). Factors such as obesity, hypertension, diabetes, and smoking, may directly impair vascular (57) function including penile blood vessels, and are therefore now recognized as risk factors for ED (15,16). Given that ED is an early manifestation of CVD as described earlier (6), in patients with CVD the penile vasculature may already be damaged and erectile function may be reduced. ...
Background: The cardiometabolic index (CMI), a new metabolic index, has had few studies exploring the relationship with erectile dysfunction (ED).
Objective: The aim of this study was to assess the association between CMI and ED in among U.S adult men from the National Health and Nutrition Examination Survey (NHANES).
Methods: The data for this study relied on the NHANES database. We used data from two separate NHANES datasets for the analysis: 2001-2002 and 2003-2004. Calculate CMI index: Triglyceride (TG) (mmol/L)/ High density lipid-cholesterol (HDL-C) (mmol/L) ×waist-height ratio (WHtR). We used multivariate logistic regression, subgroup analysis, and dose-response curves to assess the relationship between CMI and ED.
Results: From 2001 to 2004, 1367 adult male participants were identified. Multivariate logistic regression analysis showed that in the fully adjusted model 2, CMI was significantly associated with ED (OR=1.49, 95% CI: 1.09, 2.04) (p=0.017). Subsequently, we convert the CMI from a continuous variable to a categorical variable (tertile), the results showed that the risk of ED was significantly increased in the T3 group compared with the T1 group in the adjusted model 2 (OR=2.07, 95% CI: 1.12, 3.83, P=0.024). In the fully adjusted model 2, the results of the subgroup analysis showed that age ≥50 years (OR=2.31, 95% CI: 1.35, 3.95, P=0.005), BMI >30 kg/m2 (OR=1.78, 95% CI: 1.10, 2.90, P=0.023), hypertension (OR=1.89, 95% CI: 1.63, 3.45, P=0.020), diabetes mellitus (OR= 1.67, 95% CI: 1.13, 2.47, P=0.015), cardiovascular disease (CVD) (OR=1.54, 95% CI: 1.12, 2.10, P=0.011) and smoking (OR=2.07, 95% CI: 1.26, 3.39, P=0.007) categories were associated with a higher prevalence of ED
Conclusions: This study demonstrates a strong association between CMI and ED and an increased risk of ED with higher CMI levels. More prospective studies with large samples and good designs are needed to validate our results in the future
... The Massachusetts Male Aging Study (MMAS) discovered that diabetic men have a threefold higher risk of developing erectile dysfunction (ED) than non-diabetic men 66 . ED in diabetes is associated with peripheral vasculopathy, neuropathy, and chronic hyperglycemia-induced micro-and macrovasculopathy, including endothelial dysfunction. ...
Sexual or erectile dysfunction (ED) is the ineptitude to get or keep a hard penile erection. ED can have a detrimentaleffect on physical and psychological health. This review helps in understanding the detailed etiology of ED and variousapproaches for the management of ED. The occurrence and incidence of erectile dysfunction are on the rise among men.Various other factors greatly impact the progression of ED, including individual general health and physiological conditions suchas psychiatric or psychological problems, diabetes mellitus, genitourinary disease, cardiovascular disease, and chronic diseases.Erectile dysfunction occurs when the release of nitric oxide (NO) triggers the activation of the guanylate cyclase enzyme in thespongiosum and corpora cavernosa, leading to relaxation of the vascular smooth muscle and an increase in cyclic guanosinemonophosphate (cGMP) levels. This physiological process is essential for achieving and maintaining a firm penile erection. Somecommon and advanced methods, such as the physical method, sexual history, laboratory testing, apomorphine test, NPTR test,and color duplex Doppler ultrasound test, are used to diagnose erectile dysfunction. This review also focuses on emergingtreatments that address the medical need for effective ED management. This comprehensive review bridges gaps in the currentliterature, offering superior insights into ED management and improving the quality of life for individuals with ED.
... Furthermore, its prevalence increased in line with aging and the emergence of aging-related comorbidities [3]. In some studies, it was reported that the prevalence of ED was as high as 52% [4]. Therefore, ED can be considered a public health problem affecting the patients' quality of life and psychological health. ...
Purpose
Erectile dysfunction (ED) is a worldwide health problem. Oral phosphodiesterase type 5 inhibitors (PDE5I) are used in its first-line treatment. This study aimed to compare the effects of hyperbaric oxygen (HBO) treatment with PDE5I treatment and determine the patient-dependent factors affecting the efficacy of the HBO treatment and duration of action of HBO treatment.
Methods
Adult male patients who presented to the HBO unit for HBO treatment with non-urological indications and had ED based on the International Index for Erectile Function (IIEF-5) constituted the target population of this study. Participants were given HBO treatment (Group 1), no treatment (Group 2), or daily oral tadalafil 5 mg treatment (Group 3). The treatment duration was 1 month. Patients were assessed by IIEF-5 both initially and after the completion of 1 month.
Results
There were significant increases in the mean IIEF-5 scores of the patients in Group 1 and Group 3 (p < 0.001, p < 0.001). However, there was no significant improvement in Group 2 (p = 0.496). Also, the post-treatment IIEF-5 scores of Group 1 and Group 3 were significantly higher than Group 2 (p < 0.001). There was no significant difference between the IIEF-5 scores and ∆IIEF-5 values of Group 1 and Group 3 (p = 0.166, p = 0.093). Evaluation regarding comorbidities revealed that patients with the peripheral vascular disease did not improve with HBO treatment (p = 0.285).
Conclusion
HBO can improve erectile functions, and it can be a reasonable alternative for patients who cannot use PDE5Is due to comorbidities or treatment side effects.
... После перенесенного ИМ сексуальная активность снижается на 22-75%, являясь комбинацией физиологических и психологических факторов [38]. Такие факторы риска ИБС, как возраст, АГ, гиперхолестеринемия, СД и курение, являются также факторами риска ЭД [39]. В исследовании TOMHS [40] больные АГ принимали ацебутолол, амлодипин и эналаприл. ...
... [10] Erectile dysfunction (ED) affects more than half of the males between the ages of 40 and 70. [11,12] The role of oxidative stress in ED has been investigated in several studies. In in -vitro studies, it was observed that the increased production of reactive oxygen species (ROS) reduced the erectile response of the corpus cavernosum. ...
... Low testosterone and sexual dysfunction frequently coexist, although it is unknown how important low testosterone is in predicting death compared to sexual symptoms [22]. Over 50% of men between the ages of 40 and 70 experience erectile dysfunction, which is a common health issue in older men [23]. Even though more common as people get older, it is not a natural aspect of the aging process. ...
Purpose
Erectile dysfunction is defined as the inability to achieve and/or maintain an erection of sufficient rigidity and duration to permit satisfactory sexual performance. The purpose of this study is to assess the prevalence of erectile dysfunction and associated factors among adult diabetic men on follow-up at Goba and Robe hospitals, Bale Zone, South East Ethiopia,2022.
Methods
Hospital-based cross-sectional study design was used among 420 adult diabetic men from March 1 to April 30 using a systematic random sampling technique. An international index of erectile function questionnaire containing five questions was used to assess the outcome variable. The data were entered, edited, and coded using Epidata version 4.6 and analyzed using SPSS version 26. Bivariable and multivariable binary logistic regression analysis were performed to identify factors associated with erectile dysfunction. Adjusted odds ratios with their corresponding 95% confidence interval were computed to estimate the strength of association. Statistical significance was declared at p-value < 0.05.
Results
The prevalence of erectile dysfunction was found to be 354 (84.3%). Multivariable logistic regression revealed that erectile dysfunction is significantly associated with old age (AOR = 12.39, 95% CI:5.10–30.08), inadequate physical activity (AOR = 4.15, 95% CI:1.33–12.97), and being rich (AOR = 2.62, 95% CI = 1.21–5.66).
Conclusion
The prevalence of erectile dysfunction in this study population is nearly nine out of ten. Age, inadequate physical activity, and wealth index were independent predictors of erectile dysfunction. Assessment and management of erectile dysfunction in diabetic clinics should be routine medical care.
... As a result of ED, patients and their partners can experience significant difficulties with their quality of life [2]. The Massachusetts Male Aging Study, conducted among individuals aged 40 to 70 years, revealed that mild or moderate ED was prevalent in 52% of the population, while the prevalence of complete ED increased from 5 to 15% with advancing age [3]. A survey of the epidemiology of ED in people aged 40 to 70 in four countries also indicated a prevalence of 9-54% with increasing age [4]. ...
Background
Polyunsaturated fatty acids (PUFAs) have demonstrated significant therapeutic potential across a wide range of disease. The aim of this study was to investigate the potential impact of PUFA intake on the prevalence of erectile dysfunction (ED).
Methods
The study included a total of 3730 participants from the National Health and Nutrition Examination Survey (NHANES) 2001–2004. Univariate analysis, multivariate regression analysis, subgroup analysis and machine learning were utilized to explore the relationship of variables to ED. Dose response curves were constructed to observe the linear or nonlinear relationship between PUFA intake and the prevalence of ED. Propensity score matching (PSM) was used for sensitivity analysis. Finally, the potential mechanistic link between PUFA intake and ED was explored.
Results
Through univariate and multivariate regression analysis results before and after PSM and XGBoost algorithm model results, arachidonic acid (AA) was chosen as the main research object. The consumption of AA was found to be associated with a decreased prevalence of ED under the fully adjusted model [OR = 0.33 (0.20, 0.56), P < 0.001]. The interaction between AA and education was found in the subgroup analysis. Dose-response curves indicated a linear negative correlation between AA intake and the prevalence of ED. The above results were confirmed in the data analysis after 1:1 PSM. In addition, AA intake was associated with a decrease in inflammatory biomarkers and homocysteine.
Conclusions
The results suggest that AA intake is negatively correlated with the prevalence of ED. Further, anti-inflammatory and anti-endothelial damage may play a role in this.
... ED may significantly impact psychosocial health, compromising the quality of life of men affected and their partners [3,4]. Epidemiological data have shown an overall prevalence of 40-50% ED in men aged 40-70 years, with age at first presentation significantly decreasing over the past decades [5][6][7][8][9]. Indeed, more and more young men reported ED, and previous studies showed how they could easily obtain PDE5-is prescription from friends, relatives, colleagues, or by the internet, without any proper medical advice [10]. ...
Several previous studies on YouTubeTM information on medical topics have already been published. The current study aimed to evaluate the quality information of YouTubeTM videos on Phosphodiesterase 5 inhibitors (PDE5-is). A systematic search on YouTube™ was conducted using 30 keyword combinations. For each keyword’s combination, the first 50 videos were recorded. The quality of videos on YouTube™ was assessed with Patient Education Materials Assessment Tool for audio‐visual content (PEMAT A/V), DISCERN score and a specified created Misinformation tool. According to the selection criteria, 229 YouTube™ videos were suitable for the analyses. Videos were stratified according to the five main identified topics: sildenafil [n = 98; 42.79%] vs tadalafil [n = 50; 21.83%] vs vardenafil [n = 44;19.21%] vs avanafil [n = 17; 7.42%] vs PDE5-is in general [n = 20; 8.73%]. The median overall PEMAT A/V Understandability score and Actionability score were 55% (interquartile range [IQR]: 42–75) and 0% (IQR = 0–67), respectively. Specifically, according to our stratification, YouTube Videos on avanafil reached higher values of both Understandability and Actionability (72.7% and 66.7, respectively) in contrast to other categories. According to DISCERN tool, the total overall median score was 29.5 (IQR = 18–41). According to Misinformation scale, the item 1 (‘sexual stimulation’) harboured an overall median score of 2 (IQR = 1–2); the item 2 (‘side effects’) an overall median score of 2 (IQR = 1–3); the item 3 (‘treatment choices’) an overall median score of 1 (IQR = 1–2); the item 4 (‘contraindications’) an overall median score of 2 (IQR = 1–2). YouTube™ is a fast and open-access source for mass information. The overall quality of the PDE5-is contents provided is sadly unsatisfactory. Nowadays, YouTube™ cannot be recommended as a reliable source of information on PDE5-is.
... ED has become a widespread problem, with an estimated 320 million people suffering by 2025 [2]. The Massachusetts Male Aging Study found that up to 52% of men aged 40-70 struggle with ED [3]. The discovery of phosphodiesterase-5 inhibitors Processes 2023, 11, 3019 2 of 13 (PDE5Is) for inducing penile erections was a side effect of testing their capacity to cure hypertension and angina. ...
This study aimed to develop and verify a simple HPLC-based quantitative approach to simultaneously determine the phosphodiesterase-5 inhibitors (PDE5Is) sildenafil, vardenafil, udenafil, avanafil, and tadalafil in a tablet dosage form mixed with honey obtained form Jordanian market in rat plasma. PDE5Is block phosphodiesterase-5 (PDE-5). This blockage, in turn, triggers vasodilation by phosphorylating downstream effector molecules. Chromatographic separation was performed on a HypersilTM C18 column (150 mm × 4.6 mm, 5 µm, Thermo Fisher Inc., Waltham, MA, USA). An acetonitrile:10% Triethylamine solution (57:43) at pH 5.5 (adjusted with orthophosphoric acid), 20 µL injection volume, 1 mL/min flow rate, 25 °C temperature, and eluent monitoring at 250 nm was used to execute the current approach. Linearity was observed in the 9.6–14.4 µg/mL concentration ranges for sildenafil, udenafil, avanafil, and tadalafil, and 2.4–3.6 µg/mL for vardenafil. Each dosage form was recovered within acceptable limits at three distinct concentrations, and the assay selectivity indicated no interference from the inactive substances in the formulation. Sildenafil, vardenafil, udenafil, avanafil, and tadalafil had retention times of 3.5, 4.3, 6.2, 9.7, and 12.8 min, respectively, and tadalafil was 12.8 min. The present analytical method is comprehensive and universal for measuring the five drugs. Such an analytical method can be routinely used to detect the combination of these drugs.
... A well-documented metaanalysis demonstrated that ED significantly increases the risk of CVD (Chung et al., 2011). Therefore, risk factors for CVD such as hypertension, dyslipidemia, diabetes, smoking, and obesity are also applicable to ED (Feldman et al., 1994;Dong et al., 2011). ...
Background
Several observational studies have reported the correlation between gut microbiota and the risk of erectile dysfunction (ED). However, the causal association between them remained unestablished owing to intrinsic limitations, confounding factors, and reverse causality. Therefore, the two-sample Mendelian randomization (MR) study was performed to determine the causal effect of gut microbiota on the risk of ED.
Methods
The MR analysis utilized the publicly available genome-wide association study (GWAS) summary-level data to explore the causal associations between gut microbiota and ED. The gut microbiota data were extracted from the MiBioGen study ( N = 18,340), and the ED data were extracted from the IEU Open GWAS (6,175 ED cases and 217,630 controls). The single nucleotide polymorphisms (SNPs) served as instrumental variables (IVs) by two thresholds of P -values, the first P -value setting as <1e-05 (locus-wide significance level) and the second P -value setting as <5e-08 (genome-wide significance level). The inverse variance weighted approach was used as the primary approach for MR analysis, supplemented with the other methods. In addition, sensitivity analyses were performed to evaluate the robustness of the MR results, including Cochran's Q test for heterogeneity, the MR-Egger intercept test for horizontal pleiotropy, the Mendelian randomization pleiotropy residual sum, and outlier (MR-PRESSO) global test for outliers, and the forest test and leave-one-out test for strong influence SNPs.
Results
Our results presented that the increased abundance of Lachnospiraceae at family level (OR: 1.265, 95% CI: 1.054–1.519), Senegalimassilia (OR: 1.320, 95% CI: 1.064–1.638), Lachnospiraceae NC2004 group (OR: 1.197, 95% CI: 1.018–1.407), Tyzzerella3 (OR: 1.138, 95% CI: 1.017–1.273), and Oscillibacter (OR: 1.201, 95% CI: 1.035–1.393) at genus level may be risk factors for ED, while the increased abundance of Ruminococcaceae UCG013 (OR: 0.770, 95% CI: 0.615–0.965) at genus level may have a protective effect on ED. No heterogeneity or pleiotropy was found based on the previously described set of sensitivity analyses.
Conclusion
Our MR analysis demonstrated that the gut microbiota had inducing and protective effects on the risk of ED. The results provide clinicians with novel insights into the treatment and prevention of ED in the future. Furthermore, our study also displays novel insights into the pathogenesis of microbiota-mediated ED.
... by the age of forty, approximately forty percent of men are afflicted by this condition, while by the age of seventy, the prevalence rises to over seventy percent among males. The incidence of total ED exhibited a notable rise, ranging from five percent among individuals aged forty to fifteen percent among those aged seventy [2]. ED can be categorized into two primary etiologic categories: ...
Background: One developing strategy for the treatment of Erectile Dysfunction (ED) involves the utilization of noninvasive low intensity extracorporeal shockwave (LI-ESWT) therapy. This method shows promise in enhancing erectile function, while also demonstrating satisfactory levels of safety and efficacy. The objective of the present investigation was to assess the safety and effectiveness of LI-ESWT in comparison to phosphodiesterase type 5 inhibitor (PDE5i) treatment for males experiencing mild to moderate ED. Methods and Patients: This prospective randomized controlled trial (RCT) was done on sixty male individuals with ED with mild to moderate ED degree (index of erectile function (IIEF 5) =twelve-sixteen), married with stable heterosexual relationship for more than six months, proved to had vasculogenic ED etiology and vasculogenic ED by doppler,. Patients were randomly categorized into two equal groups by (Block randomization). Group A: underwent LI ESWT and Group B: received sildenafil hundred mg on demand. Results: There was a important development in Erectile Hardness Score (EHS), IIEF-5, self- esteem and relationship (SEAR) scores at the treatment of the first and third months of in both groups when compared with level of baseline. Indicate that there were no important variance among group A and group B in terms of the IIEF-5, EHS at follow-up and baseline. Conclusions: The findings of the research indicate that Li-ESWT had comparable efficacy to sildenafil in terms of treatment outcomes, as assessed by IIEF-5, SHE questionnaire. The observed enhancements in the EHS and IIEF-5 measures indicate that both interventions effectively improved function of erectile.
... Difficulty in achieving or sustaining an erection is currently the most prevalent sexual disorder in men seeking services in sex therapy clinics (Hawton, 1982;Renshaw, 1988;Spector & Carey, 1990). The frequency of erectile dysfunction is strongly age related, as shown by data from the recent Massachusetts Male Aging Study (Feldman, Goldstein, Hatzichristou, Krane, & McKinlay, 1994). In this population-based survey of men aged 40 to 70 years, the overall incidence of erectile difficulties was 52%, with approximately three times as many men in the older age group reporting moderate or severe erectile difficulties. ...
Marked changes have occurred in the formulation and treatment of sexual disorders in the past 2 decades. Emphasis has shifted to the role of biomedical and organic factors in the etiology of sexual dysfunction, along with the growing use of medical and surgical treatment interventions. Multidimensional assessment models are widely used, particularly in the evaluation of male erectile dysfunction and sexual pain disorders. Integrated treatment approaches have also been developed, as cognitive–behavioral and couples’ therapy procedures are increasingly combined with traditional sex therapy techniques. This article reviews existing data regarding the etiology and treatment of male and female sexual dysfunctions. Despite the conceptual and technological sophistication of current approaches, treatment outcome is less than satisfactory in several areas. Further research is needed on the etiology and treatment of sexual disorders.
... ED and depression having interchanging roles are common comorbid conditions among men. There is an association between high scores of depression and frequency of moderate ED reports (Massachusetts Male Aging Study) [17] . There are many psychiatric problems in elderly individuals [18,19] . ...
... Erectile function tends to decline in aging men due to various factors, including decreased testosterone, decreased libido, changes in vasculature and endothelium, and an increased likelihood of comorbidities (eg, hypertension, diabetes, and obesity). [1][2][3] The age-related decline in erectile function manifests as erectile dysfunction (ED) in most older men, 4 which is characterized by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. 5 Men experiencing erectile difficulties may experience sexual dissatisfaction, lower quality of life, anxiety, depression, and relationship difficulties. ...
Background
The health benefits of regular aerobic exercise are well established, although there is limited high-quality evidence regarding its impact on erectile function.
Aim
To determine the effect of aerobic exercise on erectile function in men and to identify factors that may influence this effect.
Methods
This systematic review and meta-analysis included randomized controlled trials that evaluated the effects of aerobic exercise on erectile function via the Erectile Function domain of the International Index of Erectile Function (IIEF-EF). The mean difference in IIEF-EF scores between the aerobic exercise and nonexercising control groups was estimated by a random-effects meta-analysis. Meta-regression was used to evaluate the association of moderator variables on meta-analysis results.
Outcomes
The IIEF-EF score is reported on a 6-30 scale, with higher values indicating better erectile function.
Results
Among 11 randomized controlled trials included in the analysis, aerobic exercise resulted in statistically significant improvements in IIEF-EF scores as compared with controls, with a mean difference of 2.8 points (95% CI, 1.7-3.9; P < .001) and moderate heterogeneity among studies (I2 = 53%). The effect of aerobic exercise on erectile function was greater in men with lower baseline IIEF-EF scores, with improvements of 2.3, 3.3, and 4.9 points for mild, moderate, and severe erectile dysfunction, respectively (P = .02). The meta-analysis results were not influenced by publication bias or individual study effects.
Clinical Implications
Health care providers should consider recommending regular aerobic exercise as a low-risk nonpharmacologic therapy for men experiencing erectile difficulties.
Strengths and Limitations
The primary strength of this review was the generation of level 1 evidence on a topic of general interest regarding sexual health in men. However, the included studies evaluated diverse groups, which may complicate data interpretation for specific segments of the population.
Conclusion
Regular aerobic exercise can improve the erectile function of men, particularly those with lower baseline IIEF-EF scores.
... The prevalence is about 40% in men in their fourth decade of life and 67% in those in their seventh decade. The disorder is commonly associated with various physiological comorbidities, including cardiovascular diseases, diabetes mellitus, or traumatic lesions to pelvic nerves as a result of prostatectomy or cystectomy surgery [35,36]. ...
(1) Background: Malondialdehyde (MDA) is a major and stable product of oxidative stress. MDA circulates in the blood and is excreted in the urine in its free and conjugated forms, notably with L-lysine and L-serine. MDA is the most frequently measured biomarker of oxidative stress, namely lipid peroxidation. Oxidative stress is generally assumed to be associated with disease and to increase with age. Here, we review and discuss the literature concerning circulating and excretory MDA as a biomarker of lipid peroxidation in aging subjects with regard to health and disease, such as kidney disease, erectile dysfunction, and COVID-19. (2) Methods: Scientific articles, notably those reporting on circulating (plasma, serum) and urinary MDA, which concern health and disease, and which appeared in PubMed were considered; they formed the basis for evaluating the potential increase in oxidative stress, particularly lipid peroxidation, as humans age. (3) Results and Conclusions: The results reported in the literature thus far are contradictory. The articles considered in the present study are not supportive of the general view that oxidative stress increases with aging. Many functions of several organs, including the filtration efficiency of the kidneys, are physiologically reduced in men and women as they age. This effect is likely to result in the apparent “accumulation” of biomarkers of oxidative stress, concomitantly with the “accumulation” of biomarkers of an organ’s function, such as creatinine. How free and conjugated MDA forms are transported in various organs (including the brain) and how they are excreted in the urine via the kidney is not known, and investigating these questions should be the objective of forthcoming studies. The age- and gender-related increase in circulating creatinine might be a useful factor to be taken into consideration when investigating oxidative stress and aging.
... ЭД является многофакторным заболеванием; в зависимости от преобладающих причин развития выделяют психогенную, органическую (нейрогенную, эндокринную, васкулогенную, лекарственно-индуцированную и другие) и смешанную ЭД. Васкулогенная ЭД является самым распространённым ви- [4]. ...
Physiotherapy is a treatment method for a wide range of diseases of various organs and systems. Its efficacy and practicability are of the great discussions during the past few decades. In urology, this method is used for treatment of erectile dysfunction (ED) caused by a violation of the trophism of genitalia due to radical prostatectomy, atherosclerosis, diabetes mellitus, Peyronie's disease. Shock wave therapy based on the remote action of a low-intensity focused acoustic wave is one of the widely used effective physiotherapeutic methods for the treatment of vasculogenic ED. The main effects of shock waves are neoangiogenesis, nerve fibers regeneration, deceleration of the cavernous fibrosis and reduction of the sympathetic outflow. Some technologies (e.g. radio waves) in addition to those effects also warm the tissues, what accelerates metabolism and improves regenerative processes. All shockwave and radiowave technologies have already demonstrated their efficacy compared with sham control. However, in the few comparative studies, no significant difference was found in efficacy between different technologies. Clinical guidelines consider physiotherapy only as an alternative treatment for patients with mild vasculogenic ED who are refractory or unresponsive to oral vasoactive therapy. Nevertheless, some studies make it possible to judge the efficacy of physiotherapy for treatment of patients with either etiology of the ED. The result of the ED treatment does not depend on the number of treatment courses, their duration, the number of pulses per course and the periodicity of therapy sessions. Also, the original studies have some major shortcomings (i.e. a large percentage of patients dropping out of follow-up). These factors cast doubt on the organotropism of physiotherapy. So, additional comparative studies are required to determine the optimal dosing regimen and to explore the influence of physiotherapy organotropic and psychological components on the results of the treatment. The study aimed to summarize the currently available data evaluating the efficacy of different physiotherapeutic technologies, to compare the efficacy of different technologies for ED treatment.
... It is a mild vasodilator primarily used for the treatment of erectile dysfunction (ED) which is defined as the constant inability to achieve and/ or maintain a penile erection sufficient to perform a satisfactory sexual intercourse. The reported prevalence of ED varies from 6% to 64% [1][2][3][4]. The identified causes of ED are classified as organic, psychogenic, and mixed causes. ...
Tadalafil is an inhibitor of the human enzyme cyclic guanosine monophosphate-specific phosphodiesterase, type 5 (PDE-5). As a mild vasodilator, it is primarily used for the treatment of erectile dysfunction, an increasingly common condition in men. It is also used for treatment of benign prostatic hyperplasia and pulmonary arterial hypertension. Adverse events of this drug are rare. Absolute contraindications include serious cardiac disease. Despite the widespread use of tadalafil, very little is known about its toxicology in forensic pathology and its association with post-mortem redistribution. This study presents a forensic case with possible contribution of tadalafil. The administration of tadalafil might act as a concurrent cause or contributing factor for lethal cardiogenic shock in people with cardiac disease.
... Accordingly, these conditions could be targeted in individuals suffering from ED in order to increase their compliance with treatment and potentially improve PDE5I effectiveness. Indeed, several extant studies indicate that the ED prevalence in men with controlled DM is comparable to those that do not suffer from DM. [21,22,23] As testosterone balance is important for erectile and sexual function, low free testosterone was expected to correlate with ED severity, as con rmed in prior investigations. [24] Although these ndings are highly informative, they need to be interpreted in light of the study limitations. ...
To determine the predictors of phosphodiesterase type 5 inhibitor (PDE5I) treatment failure in patients suffering from erectile dysfunction in order to optimize their treatment and improve compliance, and thus patient outcomes.
Data for this retrospective study was obtained by reviewing the hospital records of patients with erectile dysfunction in whom PDE5I treatment failed as well as those in whom it was successful. After obtaining demographic information (age, marriage duration, BMI, smoking status, and comorbidities) related to all such cases laboratory test results (HbA1c, Total Testosterone, Free Testosterone, SHBG, Estradiol, FSH, LH, Prolactin, Vitamin D, Cholesterol, LDL, HDL, Triglyceride, PSA, TSH, T4, and CBC values) at the first visit were recorded for inclusion in analyses. Subsequent analyses focused on comparing the group of patients in whom PDE5I failed (n = 288)—denoted as treatment group—with the age-matched control group (n = 225) in whom PDE5I was successful.
Analyses of all gathered data revealed statistically significant differences in HbA1c (p < .0001), free testosterone (p < .0001), and SHBG (p < .002) values between the treatment and the control group.
Phosphodiesterase type 5 inhibitor (PDE5I) failure is more likely to occur in diabetic patients with high levels of HbA1c, low free testosterone and high SHBG. Thus, management of these conditions could improve treatment outcomes in this patent cohort.
... Diabetes can lead to nerve damage, affecting the transmission of signals required for an erection (Feldman et al., 1994).Men with T2DM often have reduced testosterone levels, which can further contribute to ED (Dhindsa et al., 2004).The psychological stress of managing a chronic disease like diabetes can contribute to ED (Bacon et al., 2003). ...
This research aimed to elucidate the prevalence of erectile dysfunction (ED) in men with Type 2 Diabetes Mellitus (T2DM) in Osun State, Nigeria. This is a cross-sectional study involving 200 T2DM patients and 100 non-diabetic controls, selected through random sampling. Structured questionnaires were used to collect data on demographic information, medical history, lifestyle habits, psychological and emotional statuses, and experiences related to erectile function. Anthropometric parameters including height, weight, waist circumference (WC), and waist-hip ratio (WHR) were measured. A significant proportion of T2DM patients experienced erectile dysfunction compared to the control group (62.5% vs 37.0%, p<0.0001). The prevalence of ED was notably higher in individuals who had been diagnosed with T2DM for a longer duration. Pertinently, T2DM patients had higher incidences of complications such as high blood pressure and heart disease, and were more likely to have a history of surgeries or injuries related to the pelvic or genital area. Furthermore, diabetic individuals had significantly higher values in anthropometric parameters such as BMI, WC, and WHR compared to controls, all potentially contributing to the heightened prevalence of ED in this group. The study unearthed a substantial prevalence of erectile dysfunction among T2DM patients in Osun State, Nigeria, with notable associations to both physical and psychological health parameters. The findings suggest a critical need for integrated management approaches addressing lifestyle modifications, psychological support, and timely medical interventions to improve the quality of life of T2DM patients facing erectile dysfunction.
... Keywords Benign prostatic hyperplasia · Ejaculation preservation · Endoscopic surgery · Ejaculatory dysfunction · Consensus · Recommendations [8]. As a matter of fact, a recent systematic review regarding the values, preferences, and expectations of men toward treatment showed a clear preference for conservative lowerrisk management options that have fewer sexual side effects [9]. ...
Purpose
Ejaculatory dysfunction is the most common side effect of benign prostatic hyperplasia surgery. Modified techniques have emerged with the aim of preserving antegrade ejaculation without compromising obstruction relief. None are standardized or validated. The PARTURP study is a randomized study investigating partial versus complete prostate resection. We conducted an investigator consensus meeting to define the ideal surgical technique to achieve both correct obstruction relief with ejaculation preservation.
Methods
An expert consensus meeting involving all investigators of the PARTURP study took place to define a common technique using the nominal group methodology. The objectives were to define the areas to be resected and the areas to be preserved; to define the criteria for proper obstruction relief; to define the criteria for proper ejaculation preservation.
Results
All investigators (n = 15) attended the consensus meeting, and agreement between all the participants was obtained. The anatomical landmarks to be preserved are located around the verumontanum and along the posterior part of the prostatic urethra. These structures must be preserved up to 2 cm from the verumontanum. The participants agreed on the need to preserve the urethral mucosa in all the areas to be preserved and to reach the enucleation plane in the areas of resection.
Conclusions
Anatomical landmarks for ejaculation-sparing surgery have been defined by the investigators of the PARTURP randomized study. These landmarks will be used during the study, and the clinical outcomes of this ejaculation-sparing technique will be compared with complete resection with up to 3 years follow-up.
... Erectile dysfunction (ED) is defined as the persistent inability to achieve and maintain an erection for adequate to carry out satisfactory sexual acts (1,2). The burden of ED is commonly higher among people with chronic diseases, including men living with human immunodeficiency virus (MLHIV) (3)(4)(5)(6). ...
Background
The extent of the burden of erectile dysfunction and its associated factors remains unclear. The aim of this study was to investigate the factors associated with ED and its prevalence among MLHIV in northern Tanzania.
Methods
A hospital-based, multi-center, cross-sectional study was conducted on MLHIV aged 18 years and above in northern Tanzania.
Outcome
The risk factors for ED and the prevalence of such risk factors among MLHIV was assessed and evaluated through a multivariate logistic regression analysis adjusted for depression symptoms using the Patient Health Questionnaire-9 (PHQ9) scale; anxiety disorders using the Generalized Anxiety Disorder Assessment (GAD-7); ART adherence; viral load; initial regimen date; ART regimen; and sexual risk behaviors.
Results
Data for 366 participants with a median age of 50 years (IQR 38–57 years) were available for analysis. Approximately three in four (74.6%) MLHIV had ED (of any severity), whereas 37.7% had mild ED. The majority (96.5%) of the participants had low testosterone, two in three (66.7%) had depressive symptoms, and close to half of the participants (48.4%) had anxiety. Age, lack of engagement in vigorous physical activity, depression, and self-reported good adherence to antiretroviral therapy (ART) were associated with ED in a multivariate logistic regression analysis ( p =0.004, p =0.006, p =0.07, p =0.006, and p =0.004, respectively).
Conclusion
There is a high prevalence of ED among MLHIV in northern Tanzania. Erectile dysfunction should be regarded as one of the comorbidities associated with HIV and should be routinely screened for among MLHIV in CTC clinics.
... ED not only affects the patient but also has a negative impact on the social and psychological life of their partner, resulting in a diminished quality of life for both individuals. Therefore, it is also recognized as a familial and social disorder [7][8][9][10]. ...
Purpose:The purpose of this study was to evaluate the informative value of Turkish videos submitted to YouTube about erectile dysfunction (ED). Materials and Methods: The first 125 videos published on Youtube.com between January 11 and 18, 2023, accessed with the keyword "erectile dysfunction," published in Turkish, and displayed in search results in a standard order of relevance were studied. Videos that were less than 1 minute long, do not contain information, contains jokes, movie trailers, or product advertisements, were less than 1 month old since their publication, or were unrelated to ED were excluded from the study. The quality of the information content of the videos was assessed using DISCERN scoring. The obtained data were analyzed using SPSS Statistics 24 software. Results: It was determined that out of the 100 videos that met the inclusion criteria, 74% were uploaded by healthcare professionals, 3% by the Pharmaceutical Industry, 5% by the Dietary Supplement Industry, 3% by psychologists, and 15% by non-healthcare professionals. When the videos were examined based on their content, it was determined that the topics of the published videos primarily focused on diagnosis and treatment. However, it was also found that there were videos that provided content on the etiopathology and symptoms of the disease. The total duration of the videos was 10 hours, 58 minutes, and 24 seconds (1 minute to 53.05 minutes). While the total number of views was 21.893.514 (15-1.700.000), the total number of likes was determined to be 130,340. The average views were 8.002,64 (1.998,76-11.953,26), and the average monthly likes were 47,30 (11,88-73,1). The average value for DISCERN was calculated to be 3.3 (1-5). There was a negative correlation between the DISCERN scores and the average monthly number of likes. It was found that there was a positive and significant correlation between the duration of videos and DISCERN scores. Videos uploaded by physicians had a high DISCERN score, while the content quality of the other videos was moderate to poor. Conclusions: Overall, 50% of ED-related videos on YouTube have moderate to poor content quality. Videos uploaded by physicians had high DISCERN scores and high likes and view rates. A negative correlation existed between DISCERN ratings and average monthly likes and views.
... 7,8 By 2025, it is estimated that the global prevalence of ED will be 322 million. 9 Diabetes mellitus, cardiovascular disease, hypertension, obesity, smoking, depression, and lower urinary tract symptoms (LUTS) have an impact on sexuality and are major risk factors for development of ED. 5,8,10,11 Patients with LUTS are associated with a wide range of diagnoses, one of which is benign prostatic hyperplasia (BPH). Men with BPH-LUTS may have an increased smooth-muscle tone and reduced level of nitric oxide, resulting in ED. [11][12][13] The LUTS are associated with urinary obstruction caused by benign enlargement of the prostate. ...
Objective
To compare health-care resource utilization (HCRU) outcomes in patients with erectile dysfunction (ED) and benign prostatic hyperplasia-associated lower urinary tract symptoms (BPH-LUTS) treated with tadalafil or non-phosphodiesterase-5 inhibitor (PDE5i), adherence to and persistence with tadalafil by dose in the United States (US).
Methods
This was a noninterventional, real-world evidence study of men (aged ≥45 years) with ED and BPH-LUTS treated with tadalafil or non-PDE5i. The IQVIA US PharMetrics Plus claims database was used. Outcomes included all-cause and disease-specific HCRU over a 12-month follow-up. Persistence with and adherence to tadalafil were evaluated stratified by dose (10 or 20 mg as needed; 2.5 or 5 mg as once daily [OD]).
Results
The final sample comprised 11,351 tadalafil and 48,722 non-PDE5i patients. For all-cause and disease-specific HCRU, including prescription fills, physician office visits, emergency room visits, laboratory tests, radiology examinations, outpatient surgical services, ancillary services, hospitalizations, mean number of utilizations, and proportions of patients with one or more utilizations, were lower for tadalafil compared with non-PDE5i patients. For all-cause HCRU, proportions of patients with one or more emergency room visits (18.6% vs 21.7%, p<0.0001) and outpatient surgical visits (63.0% vs 68.8%, p<0.0001) were significantly lower for tadalafil compared with non-PDE5i patients. For disease-specific HCRU, the proportion with one or more disease-specific physician office visits (55.1% vs 91.4%), laboratory tests (34.8% vs 58.2%), outpatient surgery (24.3% vs 38.9%), or outpatient ancillary services (18.0% vs 29.8%) were significantly lower for tadalafil compared with non-PDE5i patients (all comparisons, p<0.0001). Mean persistence days (179.8 vs 61.2), proportion persistence (35.8% vs 6.5%), and mean adherence (0.5 vs 0.2) were higher for tadalafil OD doses than as-needed tadalafil doses.
Conclusion
Patients on tadalafil demonstrated less HCRU and higher persistence and adherence (OD versus as-needed tadalafil) than non-PDE5i patients, which demonstrates its benefit in the management of ED and BPH-LUTS in the US.
... In 1994, Feldman et al. [9] reported the findings of the Massachusetts Male Aging Study (MMAS), which evaluated impotence and its medical and psychosocial correlates among men aged 40-70 years. Using the MMAS instrument scale, there was a combined prevalence of minimal, moderate, and complete ED of 52%. ...
Hashimoto Thyroiditis is a chronic autoimmune disease clinically characterized by gradual thyroid failure due to the presence of specific antibodies directed to thyroid antigens. Haraku Hashimoto, a Japanese physician, first described in 1912 this condition, naming as “struma lymphomatosa” and referring to patients with goiter and intense lymphocytic infiltration of the thyroid gland [1]. Several studies have then stated that lymphocytic infiltration was the result of an immunological reaction to thyroid antigens and thyroid autoantibodies were identified [2]. Since then, Hashimoto thyroiditis has been considered an autoimmune disease characterized by the detection of serum thyroid autoantibodies, regardless of the presence of goiter.
Male erectile dysfunction (ED) increases with age and afflicts 52% of the 40–70 year old men. Neurological, endocrine, vascular, inflammatory, metabolic diseases, traumata, tumorous causes, illicit or “recreational “drugs, numerous prescription drugs, and psychological or psychiatric causes may induce ED. Diabetes mellitus is a leading cause of ED. ED can be the first sign of diabetes but also of coronary artery disease and thus requires a careful evaluation. In addition to a detailed history, ED patients need a general physical examination and may need additional urological, internal medicine, endocrinological-andrological, psychiatric and neurological assessment. Phosphodiesterase type 5 inhibitors should only be prescribed to patients at low cardiovascular risk. Various side effects and strict contraindications, such as treatment with nitrates, NO-donors, or alpha-blockers, and several others must be considered. Other ED treatments include lifestyle changes, where appropriate testosterone replacement, psychosexual counselling, intracavernous or intra-urethral prostaglandin E1 applications, vacuum erection pumps, constrictions rings, penile arterial reconstructive surgery, and penile prosthesis.
Erectile dysfunction (ED) is a pervasive problem among men, often shrouded in silence and stigma. This manuscript analysed the National Health and Morbidity Survey 2019 data to identify the prevalence of moderate to severe ED among men aged 18 and above in Malaysia and describe its associated factors. Self-administered questionnaire on ED utilised a locally validated International Index of Erectile Function. Variables on sociodemographics, risky lifestyles and comorbidities were obtained via an interviewer-administered questionnaire. The prevalence was determined using complex sampling analysis, and logistic regression was used to determine the associated factors of ED. A sample of 2403 men aged ≥ 18 participated, with a moderate to severe ED prevalence was 31.6% (95% CI 28.8, 34.6). The mean (± SD) of the total score of IIEF-5 for overall respondents was 18.16 (± 4.13). Multiple logistic regression analysis revealed a significant association between moderate to severe ED among men aged 60 years and above, single or divorcee, men without formal, primary, and secondary education, non-government employees, unemployed, and retiree, as well as physically inactive men. Focused public health interventions are necessary to improve education in sexual health, increase health promotion programs, and promote healthy ageing across the population.
Approximately one in twenty men have sperm counts low enough to impair fertility but little progress has been made in answering fundamental questions in andrology or in developing new diagnostic tools or management strategies in infertile men. Many of these problems increase with age, leading to a growing population of men seeking help. To address this, there is a strong movement towards integrating male reproductive and sexual healthcare involving clinicians such as andrologists, urologists, endocrinologists and counselors. This book will emphasize this integrated approach to male reproductive and sexual health throughout the lifespan. Practical advice on how to perform both clinical and laboratory evaluations of infertile men is given, as well as a variety of methods for medically and surgically managing common issues. This text ties together the three major pillars of clinical andrology: clinical care, the andrology laboratory, and translational research.
There has been growing interest within the space industry for long‐duration manned expeditions to the Moon and Mars. During deep space missions, astronauts are exposed to high levels of galactic cosmic radiation (GCR) and microgravity which are associated with increased risk of oxidative stress and endothelial dysfunction. Oxidative stress and endothelial dysfunction are causative factors in the pathogenesis of erectile dysfunction, although the effects of spaceflight on erectile function have been unexplored. Therefore, the purpose of this study was to investigate the effects of simulated spaceflight and long‐term recovery on tissues critical for erectile function, the distal internal pudendal artery (dIPA), and the corpus cavernosum (CC). Eighty‐six adult male Fisher‐344 rats were randomized into six groups and exposed to 4‐weeks of hindlimb unloading (HLU) or weight‐bearing control, and sham (0Gy), 0.75 Gy, or 1.5 Gy of simulated GCR at the ground‐based GCR simulator at the NASA Space Radiation Laboratory. Following a 12–13‐month recovery, ex vivo physiological analysis of the dIPA and CC tissue segments revealed differential impacts of HLU and GCR on endothelium‐dependent and ‐independent relaxation that was tissue type specific. GCR impaired non‐adrenergic non‐cholinergic (NANC) nerve‐mediated relaxation in the dIPA and CC, while follow‐up experiments of the CC showed restoration of NANC‐mediated relaxation of GCR tissues following acute incubation with the antioxidants mito‐TEMPO and TEMPOL, as well as inhibitors of xanthine oxidase and arginase. These findings indicate that simulated spaceflight exerts a long‐term impairment of neurovascular erectile function, which exposes a new health risk to consider with deep space exploration.
Purpose: to assess safety and efficacy of autologous mesenchymal bone marrow stem cell injection in penile cavernosal tissue for erectile dysfunction therapy in diabetic men. Methods: The subjects of this study were diabetic men suffering erectile dysfunction, non-responding to maximum dose of oral PDE5I. Mesenchymal bone marrow stem cells were aspirated and injected after preparation in both corpora cavernosa at 3, 9 o’clock position. Erectile function was assessed by the International Index of Erectile Function and penile Doppler study, before and after 6 months after injection. Results: 4 patients out of 10 achieve hard erection adequate for satisfactory coitus, and 2 patients achieved penile hardness with addition of pharmacological therapy with sildenafil 100mg. Peak systolic velocity increased significantly in 4 patients (2 arteriogenic and 2 mixed erectile dysfunction), from 12∼22 cm/s to 32∼69 cm/s. Variations in end-diastolic velocity increased substantially in 2 patients with venogenic insufficiency alone at follow-up from 4∼5 cm /s to -4∼-3 cm/s. Conclusions: Despite promising stem cell treatment efficacy for patients with erectile dysfunction, more clinical studies and researches are still warranted.
Introduction
Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the patient is exposed to 100% oxygen at a higher than atmospheric pressure. Over the past few decades, HBOT has been used to treat a variety of medical conditions. In recent times, there has been a rising curiosity regarding the potential therapeutic benefits of HBOT in the treatment of erectile dysfunction (ED).
Aims
The study sought to review and meta-analyze available data regarding the use of HBOT for ED, including its potential mechanisms of action and effectiveness.
Methods
We included only articles that evaluated the impact of HBOT on ED symptoms using the International Index of Erectile Function score. Prospective nonrandomized studies or randomized controlled clinical trials were included. Data extraction was performed in duplicate. Data analysis was conducted using Review Manager 5.41, and the presence of heterogeneity between studies was evaluated. The results were presented as the mean difference (MD) with 95% confidence interval (CI).
Results
A total of 5 studies that reported outcomes using the International Index of Erectile Function scores were included in this analysis. In patients with post–robotic-assisted laparoscopic prostatectomy–induced ED, the analysis showed a significant MD of −4.13 (95% CI, −6.08 to −2.18; P < .0001) in favor of the control group. Conversely, patients who received HBOT for reasons other than ED exhibited an MD of 4.58 (95% CI, 2.63 to 6.52; P < .00001). In the group that received HBOT for pure vasculogenic ED, the MD was 10.50 (95% CI, 9.92 to 11.08) in favor of HBOT. A meta-analysis of these data revealed a nonsignificant difference in erectile function scores, with an MD of 3.86 (95% CI, −2.13 to 9.86; P = .21).
Conclusion
The use of HBOT in the treatment of ED appears to be a promising approach. While further research is needed to establish the efficacy and long-term effects of this treatment, preliminary studies have shown encouraging results in terms of improving erectile function in men with vasculogenic ED.
This study utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the association between the systemic immune-inflammation index (SII) and erectile dysfunction (ED) in adult males. The SII is a novel index derived from the counts of neutrophils, lymphocytes, and platelets in the peripheral blood and serves as a comprehensive indicator of the immune response and inflammation levels. The study included 3601 participants from the NHANES 2001-2004 cycle. Covariates such as age, race, marital status, education, smoking, alcohol consumption, BMI, hypertension, and diabetes were taken into account. Weighted analysis and logistic regression models were applied to assess the relationship between SII and ED, adjusting for potential confounding factors. The prevalence of ED was found to be 6.28%. Overall, there is a linear correlation between SII (nonlinear P > .05) and ED. After adjusting for various confounding factors, a significant association was observed between high levels of the SII and ED. The odds ratio (OR) for ED in individuals with high SII levels was 1.45 (95% CI: 1.01–2.17, P = .045). Subgroup analysis further identified specific participant subgroups with a significant association between SII and ED. Our findings suggest that higher levels of the SII are independently associated with an increased risk of ED in adult males. The SII may serve as a valuable biomarker for identifying individuals at higher risk of ED and may aid in the development of tailored treatment approaches. Further research is needed to explore the underlying mechanisms and potential therapeutic implications.
Objective
The effect of antiviral drugs on the erectile dysfunction (ED) problem expressed by some patients using antiviral drugs due to chronic hepatitis B infection (HBV) was investigated.
Methods
A total of 102 male patients receiving antiviral therapy for HBVinfection without any known non-cirrhotic and comorbid disease that may cause ED and whodon’t use any drugs with an ED formation potential were analyzed through the InternationalIndex of Erectile Function test.
Results
Among the patients admitted to the study, anxiety disorder was detected as 24.5% (n = 25) and depression as 46.1% (n = 47). 70.6% (n = 72) of the patients suffered ED. Severe ED was only detected in 3 (n = 2.9%) patients. ED was detected in 70.6% of the entecavir, 64.2% of tenofovir, and 80% of Tenofovir alafenamide users ( P = 0.287). On the other hand, the logistics regression analysis revealed that the most important factors that increase the risk of ED are age (>55 age; RR: 2.66; P < 0.001), and anxiety disorder (RR: 2.30; P < 0.0001). The cumulative effect of antiviral drugs on ED was 5.7% (RR: 0.8; P = 0.156).
Conclusion
We could not find any mounting evidence relating to the effect ofcommonly used antiviral drugs for hepatitis B causing ED. The incidence rate of ED on ourpatients was at a similar rate with population studies in the literature based on society. It is notappropriate to terminate antiviral therapy in hepatitis B for this reason.
Background:
Phosphodiesterase 5 inhibitor (PDE5i) use has been linked to a number of ocular side effects, such as serous retinal detachment (SRD), retinal vascular occlusion (RVO), and ischemic optic neuropathy (ION).
Aim:
We investigated the risk for SRD, RVO, and ION in patients using PDE5is.
Methods:
We utilized the IBM MarketScan (2007-2021) Commercial and Medicare Supplemental Databases (version 2.0) for this analysis. To estimate overall events risk, Cox proportional hazard models were applied to calculate the hazard ratios (HRs) for erectile dysfunction (ED) diagnosis and the different treatments, adjusting for region, median age, obesity, diabetes mellitus, hyperlipidemia, smoking, hypertension, coronary artery disease, and sleep apnea. Additionally, the same analyses were performed to calculate the HRs for benign prostatic hyperplasia (BPH) diagnosis and the different treatments.
Outcomes:
HRs for SRD, RVO, and ION.
Results:
In total, 1 938 262 men with an ED diagnosis were observed during the study period. Among them, 615 838 (31.8%) were treated with PDE5is. In total, 2 175 439 men with a BPH diagnosis were observed during the study period. Among them, 175 725 (8.1%) were treated with PDE5is. On adjusted Cox regression analysis, PDE5i use was not associated with SRD, RVO, ION, and any ocular event when compared with ED diagnosis and other ED treatments. Importantly, as the intensity of ED treatment increased, so did the risk of ocular events. In addition, PDE5i use was not associated with SRD and ION when compared with BPH diagnosis and other BPH treatments. In contrast, in patients with BPH, PDE5i use was associated with RVO (HR, 1.14; 95% CI, 1.06-1.23). Importantly, patients with BPH receiving other medical treatment (ie, 5a reductase/alpha blocker; HR, 1.11; 95% CI, 1.06-1.16) or surgical treatment (HR, 1.10; 95% CI, 1.02-1.19) had a higher risk of RVO.
Clinical implications:
We did not observe any consistent association between PDE5i use and any ocular adverse events (SRD, RVO, and ION).
Strengths and limitations:
Because we did not have access to the patients' medical records, we recorded outcome definitions using ICD-9 and ICD-10 coding.
Conclusions:
Patients using PDE5is for ED or BPH indications did not have an increased risk of ocular events, even when compared with other treatments for ED or BPH.
Erectile dysfunction is a multifactorial problem that requires various treatment approaches based on the factors affecting disease development. Erectile dysfunction is one of the most serious clinical and social is-sues among men. It’s obvious that a full sexual life is one of the most important components of physical and mental health. Recent sociological data show that sexual health is the key not only to a good quality of life, but also to a longer life expectancy. It is noted that combining the traditional three-stage therapy – oral drugs, penile injection therapy and penile implantation – with ongoing psychotherapy can significantly improve the treatment results. Accordingly, it becomes important and crucial for a specialist to be aware of the timely referral of a patient to a psychotherapist.
Sexual medicine issues play a role in medical practice in all disorders and diseases that affect sexual functions, sexual and/or partner experience and behavior, and gender identity. Sexual disorders can also be consequences of other illnesses and/or their treatment and can manifest as the result of sexual trauma. In any case, a basic understanding of human sexuality is beneficial for clinical work, distinguished into three different dimensions (desire, reproduction, and attachment), all closely intertwined. This basic understanding also permeates the principles of sexual medical diagnostics and therapy, the couple dimension being of essential importance. As a result, an integrative approach in sexual medicine, taking somatic and psychosocial factors into account, makes it possible to deal with couple-related problems in the same way as somatic therapy options.
Sexual dysfunction in men can be manifold. Purely mechanical disorders of seminal deposition due to anatomy are to be differentiated from functional libido and orgasmic disorders, from ejaculation problems or the inability to achieve or maintain erections. While pure orgasmic disturbances are almost in all cases due to psychological or psychiatric causes, libido and erectile dysfunction may also have hormonal causes and thus be symptoms of androgen deficiency. Additional clinical symptoms of hypogonadism or objectifiable findings such as testicular atrophy, changes in secondary sexual characteristics, or ejaculate volume allow the organic genesis to be identified in pronounced cases, while in other cases the corresponding indications must be actively sought. Thus, while functional orgasmic and libido disorders are the domain of psychological psychiatric or endocrinological therapeutic approaches, this chapter deals primarily with disorders of seminal deposition and functionally or organically caused disorders of cohabitation.
Introduction:
Fertility rates in developing countries have declined over the past decades, and the trend of delayed fatherhood is rising as societies develop. The reasons behind the decline in male fertility with advancing age remain mysterious, making it a compelling and crucial area for further research. However, the limited number of studies dedicated to unraveling this enigma poses a challenge. Thus, our objective is to illuminate some of the upregulated and downregulated mechanisms in the male testis during the aging process.
Areas covered:
Herein, we present a critical overview of the studies addressing the alterations of testicular proteome through the aging process, starting from sexually matured young males to end-of-life-expectancy aged males. The comparative studies of the proteomic testicular profile of men with and without spermatogenic impairment are also discussed and key proteins and pathways involved are highlighted.
Expert opinion:
The difficulty of making age-comparative studies, especially of advanced-age study subjects, makes this topic of study quite challenging. Another topic worth mentioning is the heterogeneous nature and vast cellular composition of testicular tissue, which makes proteome data interpretation tricky. The cell type sorting and comorbidities testing in the testicular tissue of the studied subjects would help mitigate these problems.
Background
The interaction between intestinal microbiota and erectile dysfunction (ED) is less investigated. This study was performed to explore the association between intestinal microbiota and ED.
Methods
In this two‐sample Mendelian randomization (MR) study, genetic variants of gut microbiota were obtained from MiBioGen consortium containing 18,340 individuals. Six methods including inverse variance weighting (IVW), MR‐Egger, weighted median, maximum likelihood, MR robust adjusted profile score, and MR pleiotropy residual sum and outlier were used to investigate the causal links between intestinal microbiota and ED. Furthermore, reverse MR analysis was performed to exclude the causal impact of ED on gut microbiota.
Results
As revealed by the IVW estimator, the risks of ED were raised by genetically proxied Lachnospiraceae (OR: 1.27), Lachnospiraceae NC2004 group (OR: 1.17), Oscillibacter (OR: 1.20), Senegalimassilia (OR: 1.32) (All P < 0.05) and Tyzzerella‐3 (OR: 1.14, P < 0.05). It was observed that Ruminococcaceae UCG013 exerted protective effect against ED (OR: 0.77, P < 0.05). These results were consistent with other estimators in sensitivity analyses. In reverse MR analyses, genetic liability to ED did not alter the abundances of Lachnospiraceae , Lachnospiraceae NC2004 group , Oscillibacter , Senegalimassilia , Tyzzerella‐3 , and Ruminococcaceae UCG013 (All P > 0.05). No heterogeneity and pleiotropy were detected by Cochran's Q ‐test, MR‐Egger, and global test (All P > 0.05).
Conclusions
This study provided novel evidence that genetically proxied Lachnospiraceae, Lachnospiraceae NC2004 group, Oscillibacter, Senegalimassilia, Tyzzerella‐3 , and Ruminococcaceae UCG013 had potentially causal effects on ED. Further studies are needed to clarify the biological mechanisms linking intestinal microbiota to ED.
Mesenchymal stem cells (MSCs) are viewed as an increasingly promising treatment for age-related erectile dysfunction (AED). Owing to the limitations of injecting living cells, the injection of exosomes appears to be a more plausible option. However, whether MSC-derived exosomes (MSC-Exos) improve AED and their potential mechanism remains unknown. MSC-Exos were prepared and injected intracavernously into aged rats to determine their effects on AED. Masson's trichrome staining was used to ascertain the changes in the histological structure of the corpus cavernosum. Then miRNA sequencing of MSC-Exos and analysis of the critical exosomal miRNAs were performed, as well as their target pathway enrichment analysis. Real-time quantitative PCR (RT-qPCR) and Western blot assay were performed to reveal the functions of MSC-Exos in regulating the PTEN/PI3K/AKT signaling pathway. Moreover, the effects of MSC-Exos on the corpus cavernosum smooth muscle cells (CCSMCs) apoptosis are explored in vitro. The experimental data validate that intracavernous injection of MSC-Exos ameliorated erectile function in AED rats. Masson's trichrome staining shows MSC-Exos therapy restores the histological structure of the corpus cavernosum by improving the ratios of smooth muscle to collagen. The exosomal miR-296-5p and miR-337-3p target and inhibit PTEN, modulating the PI3K/AKT signaling pathway. Furthermore, exosomes inhibit the apoptosis of CCSMCs. Our findings suggest that MSC-Exos improve AED by delivering miR-296-5p and miR-337-3p to regulate the PTEN/PI3K/AKT signaling pathway. These results bode well for the therapeutic potential of MSC-Exos for AED treatment.
Background:
Sleep quality and duration have been investigated for their association with health. Insomnia affects up to one-third of adults and may impact male erectile function. In addition, medical treatments for insomnia (many of which are sedatives) may also affect erectile quality.
Objective:
To investigate the association of erectile dysfunction (ED) in patients diagnosed with and treated for insomnia.
Design, setting, and participants:
We utilized the IBM MarketScan (2007-2016) Commercial and Medicare Supplemental Databases (v 2.0). Age- and enrollment-matched controls were selected among patients without insomnia diagnosis or treatment.
Outcome measurements and statistical analysis:
Cox proportional hazard models were used to estimate the risk of incident ED (ie, diagnosis alone, or diagnosis and treatment with phosphodiesterase-5 inhibitors [PDE5i], intracavernous injection (ICI)/urethral suppositories, and penile prosthesis) after the diagnosis or treatment of insomnia while adjusting for relevant comorbidities.
Results and limitations:
In total, 539 109 men with an insomnia diagnosis were identified. Of these men, 356 575 were also medically treated for insomnia. The mean (±standard deviation) follow-up times for patients diagnosed with insomnia and those diagnosed with and treated for insomnia were 2.8 ± 1.6 and 3.1 ± 1.8 yr, respectively. Men with insomnia were more commonly smokers and had a higher number of office visits and comorbidities than controls (p < 0.001). On an adjusted analysis, both untreated and treated insomnia were associated with increased risks of ED diagnosis (hazard ratio or HR [95% confidence interval {CI}]: 1.58 [1.54-1.62] and 1.66 [1.64-1.69], respectively; p < 0.001). Similarly, men with treated insomnia had a higher risk of having ED treated with PDE5i (HR [95% CI]: 1.52 [1.49-1.55]; p < 0.001) and ICI (HR [95% CI]: 1.32 [1.14-1.54]; p < 0.001) when compared with controls. A limitation of this study was that a lack of granularity regarding patient clinical characteristics (eg, severity of disease, laboratory data, etc.) is inherent to insurance claims data. In addition, the follow-up was limited and may affect associations at longer time points.
Conclusions:
In the current report, a consistent association between insomnia and ED diagnosis was identified. Men diagnosed with insomnia only were found to have a higher risk of developing ED. Moreover, men with pharmacological insomnia treatments were more often prescribed treatments for ED. Given the prevalence of insomnia, future studies are warranted to delineate the association of insomnia and its treatment with erectile function.
Patient summary:
Insomnia affects up to one-third of adults and impact male erectile function. Men only diagnosed with insomnia were found to have a higher risk of developing erectile dysfunction (ED). Moreover, men with pharmacological insomnia treatments were more often prescribed treatments for ED.
Conditions referred to as 'male sexual dysfunctions' usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals' sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard-flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case-control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients' sexual problems and implement appropriate treatment. Thus, larger-scale studies - including prospective trials and comprehensive case registries - are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.
Objective: to study the relationship between erectile dysfunction and obesity parameters and the severity of obstructive sleep apnea in patients with arterial hypertension.
Material and methods : 71 patients with different severity of erectile dysfunction, overweight and obesity of grade 1, mild and severe obstructive sleep apnea and arterial hypertension were included in the study. The data of cardiorespiratory monitoring, anthropometric parameters of obesity were analyzed and the severity of erectile dysfunction was assessed by intracavernous pharmacodopplerography, the results were compared with the subjective opinion of patients on the degree of severity of erectile dysfunction according to the IIEF-5 questionnaire. All patients underwent psychosomatic status analysis according to the questionnaire scales: assessment of daytime drowsiness on the Epworth scale, severity of personal and situational anxiety on the Spielberger scale and depression level on the Beck scale.
Results: comparative analysis revealed statistically significant links between anthropometric data of obesity with OSA parameters (apnea/hypopnea index, desaturation index) (p<0.05), as well as the severity of erectile dysfunction (in terms of erection and dopplerography with evaluation of the of penile blood flow) (p<0.05). A statistically significant negative relationship between the quality of penile blood flow and the degree of arterial hypertension was revealed too (p=0.02). In a comparative analysis of the subjective state of erectile function and objective examination, no statistically significant association was revealed (p=0.07). As a result of the multifactorial linear regression, we have shown that with an increase of the waist circumference to the hip circumference ratio and a higher apnea/hypopnea index, the condition of penile arterial blood flow worsens, namely, a decrease in the peak systolic blood flow velocity (β=-0.39, p=0.05; β=-0.44, p=0.03, respectively). When assessing the psychosomatic state of patients, a significant correlation has been found between the severity of depression in the Beck scale and the level of personal and situational anxiety according to the Spielberger scale (p<0.05). The relationship between depression level on the Beck scale and the degree of situational anxiety with the severity of erectile dysfunction on the Juname scale has been also shown (p<0.05).
Conclusion : the combination of overweight or obesity with obstructive sleep apnea and arterial hypertension gives ground to suspect the presence of different severity of erectile dysfunction. The severity of ED is directly proportional to the level of anxiety and depression according to the questionnaire scales.
This book mainly describes organic aspects of the etiology, diagnosis, and treatment of erectile disorders. It is in this domain that most progress has taken place in recent years: research into the anatomy and physiology of the penis, new diagnostic tests, and modern physical therapies. As a consequence of these developments, it has become clear that organic factors play a role in the etiology of erectile disturbances much more often than was believed for many years. That is why one is justified in paying so much attention to the organic aspects of erectile dysfunctions. Yet, in doing this one should not lose sight of the psychosexological factors, as many erectile disorders are completely psychogenic in origin. Moreover, psychosocial or psychiatric factors always play a more or less important role in the pathogenesis and treatment of erectile disturbances, even if one has found a satisfactory organic explanation for the cause of the disorder. This chapter, therefore, presents an up-to-date review of the prevalence, classification, etiology, pathogenesis, diagnosis, and therapy of erectile dysfunction from the point of view of a psychiatrist-sexologist.
The frequency of difficulty in obtaining and maintaining satisfactory erections was studied in 198 diabetic men. The complaint of impotence was much more frequent in older patients; but by matching data on the various age-groups of diabetics against the data on the male population reported by Kinsey and his associates, the statistical significance of the twofold to fivefold increase in impotence in the diabetics was established. In the 30-34-year group, 25% of the diabetic men suffered from impotence. The incidence gradually increased with age to 53.6% for men 50 to 54 years of age. In some cases impotence was the symptom that led to discovery of an existing diabetes. The possibility of diabetes mellitus should be considered whenever a man complains of premature impotence.
The research which has assessed the incidence and prevalence of sexual dysfunctions is reviewed. Twenty-three studies are evaluated. Studies completed with community samples indicate a current prevalence of 5-10% for inhibited female orgasm, 4-9% for male erectile disorder, 4-10% for inhibited male orgasm, and 36-38% for premature ejaculation. Stable community estimates with regard to the current prevalence of female sexual arousal disorder, vaginismus, and dyspareunia are not available. Recent studies completed with clinical samples suggest an increase in the frequency of orgasmic and erectile dysfunction and a decrease in premature ejaculation as presenting problems. Desire disorders have increased as presenting problems in sex clinics, with recent data indicating that males outnumber females. Methodological limitations of these studies are identified and suggestions for future research are offered.
The purpose of this chapter is to review pharmacological effects on male erectile dysfunction. As will be documented in this chapter, a wide variety of pharmacological agents have been reported to have sexual side effects. Drugs may influence male sexual function at various levels including (1) sexual interest or desire (also termed libido), (2) the capacity to achieve and maintain an erection sufficient for coitus, (3) ejaculation, and (4) fertility. Although the issue of fertility is beyond the scope of this review, drugs that inhibit fertility often suppress hormonal secretions and may thus influence sexual behavior. This text is concerned primarly with erectile function. However, libido and ejaculation problems often coexist and interact with erectile problems. The effects of drugs on these sexual activities will also be reviewed.
Internal consistency reliability estimates were obtained for two samples of college students for the Jackson Personality Inventory using Bender's coefficient theta. In the California sample ( n = 82), values ranged from .84 to .95, with a median of .93. The Pennsylvania sample ( n = 307) yielded a range of .75 to .93, with a median of .90.
One thousand one hundred eighty men in a medical outpatient clinic were screened as to the presence of impotence. Four hundred one men (34%) were impotent, and of those, 188 (47%) chose to be examined for their problem. After a comprehensive evaluation the following diagnoses were obtained: medication effect, 25%; psychogenic, 14%; neurological, 7%; urologic, 6%; primary hypogonadism, 10%; secondary hypogonadism, 9%; diabetes mellitus, 9%; hypothyroidism, 5%; hyperthyroidism, 1%; hyperprolactinemia, 4%; miscellaneous, 4%; and unknown causes, 7%. The mean age of the impotent patients was 59.4 years, and the prevalence of alcoholism was 7%. Luteinizing hormone, follicle-stimulating hormone, testosterone, thyroxine, triiodothyronine (T3), T3 resin uptake, and prolactin studies were necessary to diagnose individual cases. We conclude that erectile dysfunction is a common and often overlooked problem in middle-aged men followed in a medical clinic.
(JAMA 1983;249:1736-1740)
• Little is known about sexual behavior among the elderly living in the community. Questions about sexual activity and its correlates were included in a clinic examination whose participants were identified by a household survey of a probability of Washtenaw County, Michigan, elderly, aged 60 years and over, on the medical, epidemiological, and social aspects of aging. Estimates of proportions based on responses at the clinic examination were also projected to the demographics of the household survey. The estimated proportions of individuals who are sexually active are 73.8% for married men and 55.8% for married women; among unmarried men and women the proportions are 31.1% and 5.3%, respectively. The levels decrease significantly with age in both genders. The estimated proportion of married men with erectile impotence is 35.3%. Significant associations were observed between having problems with mobility and the lack of sexual activity in both genders. The prevalence of impotency was significantly associated with a history of heart attack, urinary Incontinence, and the use of sedatives. The consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.
(Arch Intern Med. 1990;150:197-200)
A total of 132 consecutive patients with erectile impotence underwent extensive evaluation, including vascular evaluation with intracavernous injection of papaverine and penile duplex ultrasonography, to determine the etiology of impotence. Three vascular risk factors, smoking, diabetes mellitus and hypertension, were investigated for their impact on vasculogenic impotence. The patients were divided into four groups: one with no risk factors, one with one vascular risk factor, one with two vascular risk factors, and one with all three risk factors. The results of penile vascular evaluation in these patient groups were compared. The incidence of penile vascular impairment was found to be higher in. patients with one vascular risk factor than in those with none. The proportion of abnormal penile vascular findings significantly increased as the number of risk factors increased. These data confirm the important role of vascular risk factors, smoking, diabetes mellitus, and hypertension, in the pathogenesis of organic impotence.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Nearly 50% of the elderly (260 years) survivors of the Charleston Heart Study Cohort reported problems with becoming sexually aroused. The problem was associated with age and ranged from 30% at age 60 to 69 to over 60% at ages 80 and above. Significant predictors of arousal problems were older age, lower pulmonary function, physical disability, an increased usage of prescription drugs, and a fair or poor perception of health. Among respondents reporting no problems with arousal, the age-adjusted proportions of those reporting a frequency of sexual activity three or more times per month were White men 36%, Black men 29%, high socioeconomic Black men 47%, and White and Black women 14%. After considering age and arousal problem, the most consistent and significant predictors of frequency of sexual activity across all race-sex groups were marital status and education or income.
Erections in response to erotic films and fantasies were measured in eight hypogonadal men, with and without androgen replacement, and eight age-matched controls. Erections to films in the hypogonadal men did not differ from those of the controls and were not affected by androgen replacement. Erections to fantasy were significantly smaller and slower to develop in the hypogonadal men and did show significant improvement during androgen replacement. These preliminary results suggest that erections to certain types of stimuli are relatively independent of androgens, whereas the response to fantasy may be androgen dependent. The implications of these findings are discussed.
Drug-induced sexual dysfunction is a relatively common yet poorly understood clinical problem. The mechanisms whereby various drug classes alter sexual function remain poorly documented. An attempt has been made, based on recent advances in sexual physiology, to clarify drug-induced sexual dysfunction on the basis of possible or probable mechanisms of action. It is hoped that this approach may ultimately allow the physician to rationally select pharmacologic agents which minimize deleterious effects on libido, erection, ejaculation and orgasm.
This review examines the role of drug therapy in producing sexual dysfunction in males. While some drugs induce relatively isolated effects on the components of male sexual function, such as libido, penile erection and ejaculation of seminal fluid, in general, changes are more complex.
The arterial vascular bed of the penis has been studied histologically in postmortem material from 30 males in the age range 19 to 85 years, mean 57. Fifteen of these propositi had had diabetes mellitus of average duration of 13 years. In all males more than 38 years old, there was fibrous substitution of the longitudinal smooth muscle in the Ebner pads. Later this was complemented by fibrous proliferation of the intima, medial fibrosis, calcification, and narrowing of the lumen to obilteration from thrombi. The extent of the pathology was apparently related to both age and diabetes mellitus. The nature and extent of the changes indicate that they must necessarily lead to a limitation of the basic function of this arterial tree, i.e., to increase essentially the flow of blood to the cavernous bodies at the time of the erection. These changes can play a decisive role in explaining impotence that occurs with aging, particularly in diabetics.
In analyzing the responses of 100 predominantly white, well educated and happily married couples to a self-report questionnaire, this study examined the frequency of sexual problems experienced and the relations of those problems to sexual satisfaction. Although over 80 per cent of the couples reported that their marital and sexual relations were happy and satisfying, 40 per cent of the men reported erectile or ejaculatory dysfunction, and 63 per cent of the women reported arousal or orgasmic dysfunction. In addition, 50 per cent of the men and 77 per cent of the women reported difficulty that was not dysfunctional in nature (e.g., lack of interest or inability to relax). The number of "difficulties" reported was more strongly and consistently related to overall sexual dissatisfaction than the number of "dysfunctions."
To evaluate the hypothesis that endocrine profiles change with aging independently of specific disease states, we examined the age trends of 17 major sex hormones, metabolites, and related serum proteins in 2 large groups of adult males drawn from the Massachusetts Male Aging Study, a population-based cross-sectional survey of men aged 39-70 yr conducted in 1986-89. Group 1 consisted of 415 men who were free of obesity, alcoholism, all prescription medication, prostate problems, and chronic illness (cancer, coronary heart disease, hypertension, diabetes, and ulcer). Group 2 consisted of 1294 men who reported 1 or more of the above conditions. Each age trend was satisfactorily described by a constant percent change per yr between ages 39-70 yr. Free testosterone declined by 1.2%/yr, and albumin-bound testosterone by 1.0%/yr. Sex hormone-binding globulin (SHBG), the major serum carrier of testosterone, increased by 1.2%/yr, with the net effect that total serum testosterone declined more slowly (0.4%/yr) than the free or albumin-bound pools alone. Among the major androgens and metabolites, androstane-3 alpha,17 beta-diol (androstanediol; 0.8%/yr) and androstanediol glucuronide (0.6%/yr) declined less rapidly than free testosterone, while 5 alpha-dihydrotestosterone remained essentially constant between ages 39-70 yr. Androstenedione declined at 1.3%/yr, a rate comparable to that of free testosterone, while the adrenal androgen dehydroepiandrosterone (3.1%/yr) and its sulfate (2.2%/yr) declined 2-3 times more rapidly. The levels of testosterone, SHBG, and several androgen metabolites followed a parallel course in groups 1 and 2, remaining consistently 10-15% lower in group 2 across the age range of the study. Subgroup analyses suggested that obese subjects might be responsible for much of the group difference in androgen level. Serum concentrations of estrogens and cortisol did not change significantly with age or differ between groups. Of the pituitary gonadotropins, FSH increased at 1.9%/yr, LH increased at 1.3%/yr, and PRL declined at 0.4%/yr, with no significant difference between groups 1 and 2.(ABSTRACT TRUNCATED AT 400 WORDS)
This paper examines the relation of two personality characteristics (dominance and anger) to hormones in normally aging men. The relation of the Jackson Personality Research Form E Dominance subscale and the Spielberger Anger Expression scale to serum levels of 17 endocrine variables, including testosterone (T) and dihydrotestosterone (DHT), cortisol, and prolactin, was examined in 1709 men aged 39 to 70 years randomly sampled from the Boston Metropolitan Statistical Area. Canonical correlation analysis resulted in the identification of a personality profile characterized as dominant with some aggressive behavior that tends to correlate with a hormonal pattern labeled the "availability of androgens." These results partially support previous findings in animals, adolescents, and criminal populations that "aggressive dominance" is related to testosterone.
We investigated the relationship between cigarette smoking and atherosclerosis of the hypogastric-cavernous arterial bed by evaluating arteriograms of young impotent men referred for selective pudendal angiography. Those patients with hemodynamically significant atherosclerosis had smoked more pack-years than had patients without arterial disease. These differences were statistically significant (p less than 0.05) for the common penile artery (32.8 pack-years, 40 patients versus 22.3 pack-years 57 patients) and the dorsal artery (31.3 pack-years, 48 patients versus 22.0 pack-years, 49 patients). The effect of cigarette smoking as an independent risk factor for atherosclerotic disease in the hypogastric-cavernous arterial bed was evaluated as well. When controlled for age, trauma history, hypertension and diabetes, cigarette smoking was independently associated with atherosclerosis in the internal pudendal artery (p less than 0.05). The relative risk (and 95% confidence interval) of developing internal pudendal artery atherosclerosis for each 10 pack-years smoked was 1.31 (1.05 to 1.64). A third analysis investigated the potential interactive effects of cigarette smoking and pelvic or perineal trauma. A significantly higher incidence (p less than 0.05) of cavernous artery atherosclerosis was found among smokers with a history of chronic perineal trauma (33 patients) compared to nonsmokers with a similar history (25 patients). The findings of this study indicate that cigarette smoking is an independent risk factor in the development of atherosclerotic lesions in the internal pudendal and common penile arteries of young impotent men. Cigarette smoking appears to predispose these patients to early atherosclerotic lesions in the cavernous artery following chronic perineal trauma.
Experimental models have been developed to investigate the influences of anger, fear, and sleep on coronary blood flow. Studies of anger in dogs with coronary stenosis indicate that the postarousal phase is particularly conducive to myocardial ischemia. Specifically, a delayed coronary vasoconstrictor response has been observed within 1-3 minutes after cessation of behavioral arousal. The response is prevented by bilateral stellectomy and can be elicited in anesthetized animals by electrical stimulation of the right or left stellate ganglion. The latter effect is averted by alpha-adrenergic blockade with prazosin. Although the basis for the protracted nature of the delayed vasoconstriction remains to be clarified, the current hypothesis is that the phenomenon results from a time-dependent imbalance between the vasoconstrictor effects of adrenergic input and the vasodilator influences of coronary pressure and/or cardiac metabolic activity. A behavioral model emulating the fear state has also been developed. When dogs that fail to exhibit anger are placed in a food-access confrontation protocol, the animals demonstrate a fearlike state evidenced by a cowering posture and somatic tremor. There is a distinct plasma catecholamine profile that is characterized by a predominant increase in epinephrine compared with norepinephrine. This is in contrast to the pattern observed during anger, in which a prevalent increase in norepinephrine is observed. Fear results in significant increases in heart rate, arterial blood pressure, and coronary arterial flow. Sleep is also associated with substantial alterations in coronary hemodynamic function.(ABSTRACT TRUNCATED AT 250 WORDS)
The relation of the reproductive endocrine system to impotence in older men was examined by measuring the concentrations of testosterone (T), bioavailable testosterone (BT), LH, and PRL and body mass index (BMI) in 57 young controls (YC), 50 healthy potent older controls attending a health fair (HF), and 267 impotent patients (SD). The SD and HF had markedly reduced mean T and BT values compared to YC. When adjusted for age and BMI there was no difference in BT between potent and impotent older men. The percent BT was much higher in YC than in the older groups. While the percent BT rose significantly with increased T in YC, it was inversely related to T in the older subjects, suggesting that increased sex hormone-binding globulin binding was a primary event leading to a low BT. Forty-eight percent of HF and 39% of SD were hypogonadal, as defined by a mean BT of 2.5 SD or more below the mean of YC (less than or equal to 2.3 nmol/L). Ninety percent of these had LH values in the normal range, suggesting hypothalamic-pituitary dysfunction. Thirty-four SD and six each of YC and older control volunteers (OC) underwent GnRH testing. Older subjects showed impaired responsiveness to GnRH compared to YC. A low basal LH level correlated very highly with hyporesponsiveness to GnRH. Thus, secondary hypogonadism and impotence are two common, independently distributed conditions of older men.
Because many elderly men with chronic illnesses such as diabetes have multiple causes contributing to their impotence and may still retain an interest in sexual activity, those who still are unable to adequately perform sexually after treatment of their medical problems should be informed of the alternative methods of treatment of their impotence or alternative methods of sexual fulfillment and gratification and, when necessary, should be offered supportive counseling and psychotherapy.
Although the administration of estrogens and androgens can affect the concentrations of sex hormone-binding globulin (SHBG) in men, the relationships between endogenous estrogens and androgens and SHBG are uncertain. Therefore, in a randomly selected cohort of 1640 middle-aged men we measured androgen, estrogen, and SHBG concentrations and obtained the subjects' weight, ethanol intake, and smoking histories. The data were analyzed by stepwise multiple regression, with SHBG as the dependent variable, to compare the role of hormones with that of other factors in the control of SHBG levels. Neither estrone or estradiol nor the testosterone/estradiol ratio was predictive of SHBG levels. However, SHBG concentrations were positively correlated with total testosterone and negatively correlated with percent free and percent albumin-bound testosterone. SHBG concentrations were negatively correlated with estrone sulfate, but were positively correlated with the testosterone/estrone sulfate ratio and the concentrations of free and albumin-bound testosterone. In addition, in all models tested age and body mass index (wt/ht2), but not smoking or ethanol, were strong predictors of SHBG concentrations. Thus, when present in physiological amounts in the blood as a result of glandular secretion, there is a positive relationship between SHBG concentrations and testosterone and, to a lesser extent, free- and albumin-bound testosterone, but age and body mass index appear to be more important in predicting the SHBG concentration.
Hyperprolactinemia is a recognized cause of impotence. The discovery of elevated prolactin levels in impotent men is very important since pharmacotherapy in this instance is highly successful. We review our experience with prolactin determinations in impotent men, and a population is defined that may benefit from routine prolactin determination. In our experience, the predominant symptom associated with hyperprolactinemia in men is loss of libido.
Little is known about sexual behavior among the elderly living in the community. Questions about sexual activity and its correlates were included in a clinic examination whose participants were identified by a household survey of a probability of Washtenaw County, Michigan, elderly, aged 60 years and over, on the medical, epidemiological, and social aspects of aging. Estimates of proportions based on responses at the clinic examination were also projected to the demographics of the household survey. The estimated proportions of individuals who are sexually active are 73.8% for married men and 55.8% for married women; among unmarried men and women the proportions are 31.1% and 5.3%, respectively. The levels decrease significantly with age in both genders. The estimated proportion of married men with erectile impotence is 35.3%. Significant associations were observed between having problems with mobility and the lack of sexual activity in both genders. The prevalence of impotency was significantly associated with a history of heart attack, urinary incontinence, and the use of sedatives. The consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.
Patients with dyspepsia of unknown origin (DUO) and those with similar upper abdominal symptoms but with an organic cause (peptic ulcer) were assessed on personality and psychological symptom measures. The DUO patients had significantly more symptoms of anxiety and tension and higher scores for trait tension and hostility than the organic group. The two groups did not differ significantly in terms of depressive symptoms, neuroticism, psychoticism, or suppression of negative affects. The implications of these findings for the aetiology and diagnosis of DUO are discussed.
A Health Hazard Evaluation was conducted by the National Institute for Occupational Safety and Health in an area of a large chemical plant that manufactured the stilbene derivative 4,4'-diaminostilbene-2,2'-disulfonic acid, an intermediate used for the production of optical brightening agents. Men employed in the area reported problems with impotence. The study population consisted of 44 men aged 20-57 years (mean age 37) employed in the area at the time of the evaluation. An industrial hygiene investigation, health and work history questionnaire survey, physical examinations, and blood chemistry and serum hormone evaluation were conducted. Fourteen percent of the men reported symptoms of impotence over the preceding 6 or more months, 7% had potency problems of shorter duration, and 7% were not currently impotent but had experienced impotence for 6 or more months in the past; 36% experienced decreased libido, all since beginning work in the production area. Low levels of serum testosterone (less than 350 ng/dl) were observed in 37% of the men. The low serum testosterone concentrations were not accounted for fully by diurnal variation or an effect of rotating shift work. It is suggested that exposures to chemicals possessing estrogenic activity may be related to the observed health effects in these workers.
We designed an animal model to elucidate the effect of venous leakage and arterial insufficiency on erectile function. In 10 dogs, electrodes were implanted around the cavernous nerves for electroerection and blood flow in the internal pudendal artery was recorded. Venous leakage was mimicked by inserting needles of varying gauges (30 to 16G) into the corpus cavernosum and the erectile response to neurostimulation was recorded before and after the creation of the leak. The relationship between the size and the amount of the venous leakage, the changes in the intracavernous pressure (peak and drop), and the changes in the peak and maintenance arterial blood flow were documented. Arterial blood flow was then reduced by 25 and 50 per cent by means of a screw clamp on the terminal aorta. The erectile response to neurostimulation was again determined, with the same electrical parameters, first with reduced blood flow alone, then in combination with leakage of varying size. Our results showed that minor cavernous vein leakage in the presence of normal arterial flow and a healthy sinusoidal system had a minimal effect on erectile function owing to a compensatory increase in penile blood flow. However, when reduction of arterial blood flow was superimposed on venous leakage, even of a minor degree, the erectile response to neurostimulation was markedly impaired.
Male sexual functions namely libido and potency were evaluated in fourteen right handed stroke patients. Half of the studied patients had reduced libido while reduced potency was found in 86% patients. Right hemispheric stroke patients had significantly higher reduction in libido as compared to left hemispheric stroke patients. Libido may have some specific cortical or limbic representation in right cerebral hemisphere.
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.
The distribution of four main arterial risk factors (ARF) (diabetes, smoking, hyperlipidaemia (HLP), and hypertension) was investigated in 440 impotent men (mean age 46.8) in whom the penile blood-pressure index (PBPI) (ie, the ratio of the lowest systolic pressure in one of the four main arteries of the penis to the systolic pressure in the arm) was measured. In 222 the cause (organic or functional) of impotence was sought by further investigations, such as cavernosonography. 80% of this subgroup had organic impairment of erection. In 53% of these there was evidence of an arterial lesion. Smoking (64%), diabetes (30%), and HLP (34%) were all significantly more common in the 440 impotent men than in the general male population of a similar age. Whenever two or more ARFs were present mean PBPI was significantly lower. The frequency of organic impotence increased from 49% in the absence of any ARF to 100% in patients with 3 or 4 ARFs. It is concluded that increase in the frequency of impotence with age is mainly related to arteriosclerotic changes for the arteries of the penis and that the ARF and PBPI should be evaluated first in any patient complaining of impotence.
Relaxation of the smooth muscle of the corpora cavernosa of the penis is necessary for penile erection. To determine the relation of impaired relaxation to impotence in diabetic patients, we performed an in vitro examination of corpus cavernosum tissue obtained at the time of implantation of a penile prosthesis in 21 diabetic and 42 nondiabetic men with impotence. Contraction was induced in isolated strips of corporal smooth muscle by norepinephrine; then relaxation was assessed with electrical stimulation of autonomic nerves and with the administration of three agents: acetylcholine, which is known to be mediated by endothelium-derived relaxing factor; papaverine; and sodium nitroprusside. The latter two act directly on smooth muscle (i.e., they are endothelium-independent). Autonomically mediated relaxation with electrical stimulation was less pronounced in the smooth muscle from diabetic men (n = 18) than in the smooth muscle from nondiabetic men (n = 24; P = 0.001). The degree of impairment increased with the duration of diabetes (r = 0.61, P = 0.007). Endothelium-dependent relaxation was also impaired, as evidenced by a lower degree of muscle relaxation after the administration of acetylcholine in the tissue from diabetic men (n = 16) than in that from nondiabetic men (n = 22; P = 0.001). The adverse effects of diabetes persisted after we controlled for smoking and hypertension. Endothelium-independent relaxation after the administration of nitroprusside and papaverine was similar in tissue from the diabetic and nondiabetic men. We conclude that diabetic men with impotence have impairment in both the autonomic and the endothelium-dependent mechanisms that mediate the relaxation of the smooth muscle of the corpora cavernosa. These findings may provide a rationale for the treatment of diabetic men with impotence by intracavernosal injection of vasodilators to induce endothelium-independent relaxation of the smooth muscle.
It has been postulated that dehydroepiandrosterone (DHEA) and its sulfate ester, dehydroepiandrosterone sulfate (DHEAS), the major secretory products of the human adrenal gland, may be discriminators of life expectancy and aging. We examined the relation of base-line circulating DHEAS levels to subsequent 12-year mortality from any cause, from cardiovascular disease, and from ischemic heart disease in a population-based cohort of 242 men aged 50 to 79 years at the start of the study. Mean DHEAS levels decreased with age and were also significantly lower in men with a history of heart disease than in those without such a history. In men with no history of heart disease at base line, the age-adjusted relative risk associated with a DHEAS level below 140 micrograms per deciliter was 1.5 (P not significant) for death from any causes, 3.3 (P less than 0.05) for death from cardiovascular disease, and 3.2 (P less than 0.05) for death from ischemic heart disease. In multivariate analyses, an increase in DHEAS level of 100 micrograms per deciliter was associated with a 36 percent reduction in mortality from any causes (P less than 0.05) and a 48 percent reduction in mortality from cardiovascular disease (P less than 0.05), after adjustment for age, systolic blood pressure, serum cholesterol level, obesity, fasting plasma glucose level, cigarette smoking status, and personal history of heart disease. Our conclusions are limited by the single determination of DHEAS levels, but the data suggest that the DHEAS concentration is independently and inversely related to death from any cause and death from cardiovascular disease in men over age 50.
Vascular disease is a major cause of impotence in patients over the age of 40. In a prospective study of 130 impotent patients followed for 24 to 36 months, patients with a penile brachial pressure index (PBPI) of 0.65 or less had a significantly greater risk of a myocardial infarction or a cerebrovascular accident than patients with higher PBPIs. It is concluded that impotence in association with a low PBPI should be considered an indicator of a future major vascular event.
The past decade has brought increasing recognition that impotence is an extremely common problem in men over 50 years old. For example, the Baltimore Longitudinal Study of Aging has reported that by the age of 55 impotence is a problem in 8% of healthy men. For 65-year-olds, the figure is 25%; for 75-year-olds, it is 55%, and for 80-year-olds, it is 75%. More recently, my colleagues and I determined the prevalence of impotence in men who elected to have a nutritional and general-health screening at an exposition for peaople over 50. Some 27% were impotent, and they were more likely than the others to have a medical diagnosis, to be receiving medication, or to be depressed. Our finding of an increased incidence of impotence among men with medical conditions is in keeping with that of Michael Slag and colleagues, who reported that 34% of 1,180 men attending a medical outpatient clinic were impotent. In the vast majority of cases of impotence in older men, the causes are organic rather than psychogenic, although problems such as depression must be considered. Moreover, in most cases of impotence in older men, the causes are multiple, with possible contributions from a list including vascular disease, hypogonadism (primary or secondary), thyroid abnormalities, diabetes mellitus, and many widely prescribed medications.
Twelve patient referrals for evaluation of impotence comprise the subjects of a pilot study examining psychogenic and biogenic factors of erectile dysfunction. A structured interview format (KCII) was developed which allowed the clinician to estimate the likelihood of the presence of three organic factors (hormonal, neurological, cardiovascular) and three psychogenic factors (intrapsychic, relational, and behavioral) as well as the presence of relevant lifestyle factors (alcohol, smoking, exercise patterns). The results demonstrated a good ability of the KCII to accurately identify impotent patients (on the basis of history) who would have positive or negative signs of hormonal factor or neurological factor confirmed by laboratory results or physical examination. The sample of patients who had significant vascular findings did not allow for adequate comparison with interview findings. The majority of patients had significant psychogenic components to their impotence and might have been incorrectly classified as "solely psychogenic" if they had not been simultaneously evaluated for organic factors. The most important finding was that impotence, in most cases, involved multifactorial etiological components and required a comprehensive evaluation and treatment program.