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Abstract

The purposes of this study are to measure the prevalence of premature ejaculation (PE) and erectile dysfunction (ED) among a population of Swiss young men and to assess which factors are associated with these sexual dysfunctions in this age-group. For each condition (PE and ED), we performed separate analyses comparing young men suffering from the condition with those who were not. Groups were compared for substance use (tobacco, alcohol, cannabis, other illegal drugs, and medication without a prescription), self-reported body mass index, sexual orientation, physical activity, professional activity, sexual experience (sexual life length and age at first intercourse), depression status, mental health, and physical health in a bivariate analysis. We then used a log-linear analysis to consider all significant variables simultaneously. Prevalence rates for PE and ED were 11% and 30%, respectively. Poor mental health was the only variable to have a direct association with both conditions after controlling for potential confounders. In addition, PE was directly associated with tobacco, illegal drugs, professional activity, and physical activity, whereas ED was directly linked with medication without a prescription, length of sexual life, and physical health. In Switzerland, one-third of young men suffer from at least one sexual dysfunction. Multiple health-compromising factors are associated with these dysfunctions. These should act as red flags for health professionals to encourage them to take any opportunity to talk about sexuality with their young male patients.

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... 80,81 PE is a persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute after penetration and before the person wishes it. 83 In a Swiss study of men aged 18 to 25 years, 11% reported PE. 84 This and another study revealed an association between PE and poor physical health, alcohol consumption, illegal drug use, tobacco use, and less sexual experience. 84,85 ED is marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until the completion of a sexual activity, or marked decrease in erectile rigidity. ...
... 83 In a Swiss study of men aged 18 to 25 years, 11% reported PE. 84 This and another study revealed an association between PE and poor physical health, alcohol consumption, illegal drug use, tobacco use, and less sexual experience. 84,85 ED is marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until the completion of a sexual activity, or marked decrease in erectile rigidity. 83 ED prevalence among young men 18 to 25 years old approaches 30%. ...
... 83 ED prevalence among young men 18 to 25 years old approaches 30%. 84 Poor mental health, depression, and consumption of medication without prescription were predictive factors for ED. ED persistence was also associated with having multiple sexual partners. ...
Article
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Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.
... określająca ile zachowań seksualnych w tygodniu to za mało, a ile za dużo. Stworzenie takiej normy wydaje się raczej bezcelowe biorąc pod uwagę wysokie zróżnicowanie interpersonalne oraz intrapersonalne w zakresie potrzeb seksualnych (popęd w danym dniu nierzadko zależy od wielu czynników psychologicznych i środowiskowych (Mialon i in., 2012). ...
... Występowanie powyższych dysfunkcji miało bezpośredni związek ze obniżoną jakością życia (Gandek i in., 1998;Mialon i in., 2012). Przeprowadzone we Włoszech badanie wykazało, że co czwarty pacjent szukający pomocy w związku z doświadczaniem zaburzeń wzwodu miał mniej niż 40 lat (Capogrosso i in., 2013 Inni badacze przyczyn szukali wśród czynników psychologicznych, takich jak depresja i lęk (Angst, Gamma, Sellaro, Zhang i Merikangas, 2002;Bancroft i in., 2003a;Bancroft, Janssen, Strong i Vukadinovic, 2003b;Mathew i Weinman, 1982). ...
... Warto zauważyć, że w niektórych opublikowanych w ostatnich latach pracach koncentrujących się na zbadaniu współwystępowania różnego rodzaju czynników psychicznych i somatycznych z dysfunkcjami seksualnymi w młodym wieku nie brano pod uwagę problematycznego korzystania z pornografii (oraz całego spektrum kompulsywnych zachowań seksualnych) jako czynnika sprawczego (Mialon i in., 2012;Akre, Berchtold, Gmel i Suris, 2014;Nguyen, Gabrielson i Hellstrom, 2017). Zatem w dostępnej literaturze aspekt ten nie był raportowany. ...
... Recently, researchers investigated young men and women in samples with diverse relationship statuses have documented a high prevalence of problems with sexual functioning (Landry & Bergeron, 2011;Mialon et al., 2012;Mitchell et al., 2016;Musacchio et al., 2006;O'Sullivan et al., 2014O'Sullivan et al., , 2016O'Sullivan & Majerovich, 2008). For example, O'Sullivan et al. (2014) found that 54% of the young men and 49% of the young women in their Canadian sample of 16-21 year olds reported a problem with sexual functioning in the previous four weeks; the prevalence of sexual problems reported by the men and women did not differ. ...
... Only a few studies have investigated the association between these individual characteristics and the sexual functioning of adolescents and young adults. Researchers have not found differences in the sexual functioning in this population based on sexual identity/orientation or religiosity (Mialon et al., 2012) and results have been mixed with respect to the associations between sexual experience and sexual functioning (Mialon et al., 2012;O'Sullivan et al., 2014;O'Sullivan & Majerovich, 2008). Researchers have found that women, but not men, who experienced sexual coercion in adulthood are more likely to experience sexual problems Burri & Spector, 2011;Lemieux & Byers, 2008;O'Sullivan et al., 2016). ...
... Only a few studies have investigated the association between these individual characteristics and the sexual functioning of adolescents and young adults. Researchers have not found differences in the sexual functioning in this population based on sexual identity/orientation or religiosity (Mialon et al., 2012) and results have been mixed with respect to the associations between sexual experience and sexual functioning (Mialon et al., 2012;O'Sullivan et al., 2014;O'Sullivan & Majerovich, 2008). Researchers have found that women, but not men, who experienced sexual coercion in adulthood are more likely to experience sexual problems Burri & Spector, 2011;Lemieux & Byers, 2008;O'Sullivan et al., 2016). ...
Article
The research provides few insights regarding the sexual functioning of late adolescents and young adults who are currently in a committed romantic relationship, a context that likely affects their sexual functioning. We sought to identify individual and relationship factors associated with their sexual functioning. Participants were 409 individuals (172 men, 237 women; 18–24 years) who completed an online survey assessing their sexual functioning, individual characteristics, cognitive-affective appraisals of their romantic relationship, sexual frequency, and sexual communication. Significantly more women (22.8%) than men (4.7%) reported a sexual problem. These rates are lower than typically found in this age group. In addition, substantial numbers of men and women reported less than optimal sexual functioning in one or more sexual response domain that did not reach the level of a sexual problem. A hierarchical multiple regression analysis revealed that being male and reporting greater partner caring, relationship satisfaction, sexual frequency, and verbal sexual communication were unique predictors of more positive sexual functioning. One explanation for these findings is that being in a committed relationship may counter poor sexual functioning for young people because global positive feelings about the partner provide a safe context to figure out then communicate their sexual wants and needs.
... Participants completed a sexual function survey while undergoing medical screening for the military. This study found that as many as 30% of participants had varying degrees of ED. 12 When taken together, studies support the notion that ED is increasingly becoming a common concern in young men, and as such, it is important to improve awareness and appropriate screening by clinicians. ...
... Among the correlated conditions with ED, mental health demonstrated an independent association, apart from a shorter sexual lifespan, impaired physical health, and the use of medications without a medical prescription. 12 The results from this study were prospectively extended to 3,700 men assessed at baseline and 15.5 months later. Among the predictors, including drug abuse, lifestyle, body mass index, and perceived physical fitness, only depression and perceived impairment in mental health were associated with the development and persistence of ED. 79 In an internet-based study of a sample of 844 North American medical students with an average age of 25.7 years, ED was reported by 13%; ED also had a significant association with depressive symptoms, whose frequency increased as ED severity increased. ...
Article
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Introduction: Erectile dysfunction (ED) is an important health concern that can significantly affect a man's psychosocial well-being. ED has traditionally been considered a disease of old age; however, contemporary evidence suggests a growing incidence of ED in men younger than 40 years. The process of achieving an erection is multifaceted; there are many potential mechanisms that can be disrupted. It is critical to identify the specific causes of ED before proceeding with potentially costly and invasive therapeutic options. Advances in diagnostic and treatment modalities offer opportunities to identify and manage young men with ED. Aim: To provide an update on the prevalence and risk factors of ED in young men and to provide a framework to guide clinicians in identifying and managing the affected young man. Methods: Comprehensive review of the literature pertaining to ED in young men. Main outcome measures: ED in young men was assessed by outlining the prevalence according to recent epidemiologic studies. The pathophysiology, diagnostic considerations, risk factors, and etiologies were reviewed. Results: Large multinational studies have estimated the prevalence of ED in young men to be as high as 30%. Several studies have stratified the etiologies of ED into psychogenic and organic causes. Psychogenic etiologies of ED include depression, anxiety, and partner-related difficulties. These patients tend to experience sudden onset of symptoms, with decreased libido and good quality of spontaneous or self-stimulated erections. Organic etiologies include vasculogenic, endocrinologic, neurogenic, iatrogenic, and structural components. These patients usually experience gradual onset of symptoms and a low to normal libido. Conservative treatments such as phosphodiesterase type 5 inhibitors continue to be the mainstay treatment. Conclusions: ED in young men is an increasingly common condition. A careful diagnostic evaluation should focus on the identification of any underlying etiology to ensure appropriate management of patients. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sex Med Rev 2017;5:508-520.
... In total, 79 articles were excluded because they did not meet the selection criteria. Finally, 8 published articles [4,11,[17][18][19][20][21][22] were ultimately identified as relevant to our research. Agreement between the reviewers was good (Kappa statistic = 0.68). ...
... Among these, 2 studies [11,22] were cohort studies, and 6 studies [4,17 -21] were cross-sectional studies. The 9 selected studies contained a total [4,19,22] were conducted in the Europe (Germany and Switzerland); 4 were in Asia (Korea, India, and Malaysia) [11,17,18,20] , and 1 study was from Australia [21] . ...
Article
Background: Premature ejaculation (PE) is the most prevalent male sexual dysfunction. Epidemiologic findings are inconsistent concerning the risk for depression associated with PE. Objective: The aim of this study was to investigate the potential association between between depression and risk of PE. Data sources: We conducted a literature search of PubMed, Embase, and the Cochrane Library from these databases' inception through June 2014 for observational epidemiological studies examining the association between depression on risk of PE. Study eligibility criteria: Studies were selected if they reported the risk estimates for PE associated with depression. Participants: patients>18 years of age suffering from PE. Interventions: a history of depressive disorder. Study appraisal and synthesis methods: These odds ratios (ORs) were pooled using a random or fixed effects model and were tested for heterogeneity. Subgroup analysis was employed to explore heterogeneity. Results: Eight trials involving 18,035 patients were included in the meta-analysis. Depression were statistically significantly associated with the risk of PE (OR = 1.63, 95% CI:1.42-1.87). There was no evidence of between-study heterogeneity (P = 0.623, I = 0.0%). The association was similar when stratified by mean age, geographical area, study design, sample size, publication year, and controlling key confounders. Limitations: The severity of depression and PE could not be identified due to unavailable data of trials. No evidence of publication bias was observed. Conclusions: These findings provide evidence that depression is associated with a significantly increased risk of PE. In addition, more prospective studies are necessary to evaluate the association and identify the ideal treatment. Systematic review registration number: CRD42016041272.
... Historically, levels of impotence among young men have been 2% to 5% (Park et al., 2016). A range of recent studies are finding that 27% to 33% of young men age 18-40 years are having erectile difficulties and low libido rates with a real partner (Bronner & Ben-Zion, 2014;Klucken, Wehrum-Osinsky, Schweckendiek, Kruse, & Stark, 2016;Kühn & Gallinat, 2014;Mialon, Berchtold, Michaud, Gmel, & Suris, 2012;Pizzol, Bertoldo, & Foresta, 2015;Sutton, Stratton, Pytyck, Kolla, & Cantor, 2015), though not with internet pornography (Landripet & Štulhofer, 2015). Essentially, they have conditioned their brains to respond to images on a screen and not to real partners. ...
Article
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Adolescents are now significant users of internet pornography. Samples of voluntary consumption were identified from 14 countries. Considered collectively they demonstrate that boys are much more interested in viewing pornography than girls and that both genders watch more pornography as they get older. By age 18 most boys are consumers. From a risk management point of view, internet pornography has not been proven to be a safe product. It poses dangers similar to any activity that has a high potential for the development of problematic behaviors or addiction through sustained overconsumption. Until causality linking pornography consumption to harm is either disproven or demonstrated to be very low, there is a strong case for governments and policy makers to intervene in the unrestricted supply of internet pornography to all consumers, particularly adolescents. The precautionary principle should be invoked to minimize the likelihood that internet pornography consumption will become a global public health crisis. Prevention of harm is always preferable to treating it. Reducing risk from internet pornography by discouraging its consumption is relatively inexpensive and easy to do.
... In a population of more than 2,500 very young Swiss men, aged 18-25 years, participating to a survey on sexual function while attending the medical screening for the evaluation of military capability, ED had a prevalence of 30%. Among the possible correlated conditions, mental health showed an independent association, besides the use of medications without medical prescription, a shorter sexual lifespan and impaired physical health (74). The results from this Swiss study were then prospectively extended on a sample of 3,700 men evaluated at baseline and 15.5 months later (75). ...
Article
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Epidemiological studies consistently show that prevalence of erectile dysfunction (ED) increases with ageing. Nonetheless, complaints of ED even in younger men are becoming more and more frequent. Healthcare professionals working in Sexual Medicine but even those operating in different clinical contexts might be adequately prepared to answer this increasing requirement. ED in younger men is likely to be overlooked and dismissed without performing any medical assessment, even the most basic ones, such as collection of medical history and physical exam. This is due to the widespread assumption that ED in younger individuals is a self-limiting condition, which does not deserve any clinical evaluation or therapy and can be managed only with patient reassurance. However, evidence shows that, in younger subjects, organic, psychological and relational conditions can contribute to the pathogenesis of ED and all these conditions might be evaluated and treated, whenever necessary. Among the organic conditions contributing to the onset of ED, metabolic and cardiovascular (CV) risk factors are surprisingly of particular relevance in this age group. In fact, in younger men with ED, even more than in older ones, recognizing CV risk factors or conditions suggestive of cardio-metabolic derangements can help identifying men who, although at low absolute risk due to young age, carry a high relative risk for development of CV events. In this view, the assessment of a possible organic component of ED even in younger individuals acquires a pivotal importance, because it offers the unique opportunity to unearth the presence of CV risk factors, thus allowing effective and high quality preventive interventions.
... While this study did not have a comparison group from the general population, some comparisons can be made regarding the prevalence of sexual dysfunction in a general population cohort compared to this clinical cohort. In a large cohort of young men aged 18-25 in Switzerland, it was found that the prevalence of erectile dysfunction was as high as 30%, however this cohort included individuals with mental health disorders, in which the rates of sexual dysfunction were higher (Mialon et al., 2012). A further study involving young people aged 15-24 years conducted in France found a high prevalence of sexual dysfunction, with 48% of females reporting at least one form of sexual dysfunction (Moreau et al., 2016). ...
Article
The majority of mental disorders have their onset in late adolescence and early adulthood and this coincides with important stages of sexual development. Although sexual dysfunction is highly prevalent among people with mental health disorders, little is known about this topic among youth. This study aimed to evaluate the sexual functioning and subjective experience of sex in young people aged between 15 and 26 years attending a youth mental health service. One hundred and three participants were assessed with the Sexual Health Questionnaire, Sexual Functioning Questionnaire, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and the Medication Adherence Rating Scale. There were 43 males, 52 females, and 8 transgender and gender diverse participants with a range of mental health disorders. Eighty (77.7%) had experienced consensual sexual intercourse. Ninety-nine (95.8%) endorsed at least one item of sexual dysfunction and clinical sexual dysfunction was present in 37 (38.9%) cases. Sexual dysfunction was associated with greater severity of general psychopathology, negative symptoms, antipsychotic use, lower antipsychotic medication adherence, and negative subjective experiences around sex. Addressing this sexual dysfunction in young people could lead to both an improvement in subjective experiences of sexual relationships and potentially improvement in adherence to treatment.
... The 2001-2002 rates for men 40-80 were about 13% in Europe (Nicolosi et al., 2004); by 2011, ED rates in young Europeans aged 18-40 ranged from 14% to 28% (Landripet & Štulhofer, 2015). In the last few years, studies using a variety of assessment instruments have revealed further evidence that sexual difficulties are affecting as many as one in three young men (Landripet & Štulhofer, 2015;Mialon, Berchtold, Michaud, Gmel, & Suris, 2012;O'Sullivan, Brotto, Byers, Majerovich, & Wuest, 2014;Wilcox, Redmond, & Hassan, 2014). These unprecedented rates of sexual performance problems suggest that the total percentage of consumers who have been adversely affected in all ways by IP use may be significant. ...
Article
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There’s growing evidence that today’s streaming pornography videos are sui generis, with unique properties such as inexhaustible sexual novelty at a swipe, effortless escalation to more extreme material, and accessibility by youthful viewers, and that these unique properties are giving rise to severe symptoms in some consumers. Formal research on internet pornography (IP) has thus far failed to illuminate the phenomenon adequately. The usual correlation studies cannot establish which related factor causes another (or whether an effect is bi-directional). Yet establishing causation is critically important lest symptoms caused by IP overuse be confounded with evidence of psychological traits and indications of mental disorders. The most effective way to reveal the effects of IP is to ask study participants to give up IP use for an extended period and compare them with controls. A possible research design is described.
... Yet, we found that almost half the 18 to 24 year old men reported having experienced at least one SD in the past 12 months for a period of at least 3 months, with over 10 % reporting erectile dysfunction. While alcohol consumption, drug use and smoking have previously been shown to be associated with SD in young men [42,63], it was a concern that reporting a diagnosed mental health condition was the second most strongly associated factor with SD in young men. A recent longitudinal study of young men did find that men with erectile dysfunction were significantly more likely to develop or maintain depression [42]. ...
Article
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Background Sexual difficulties (SD) are common among men of all ages and can have considerable impact on quality of life and indications for future health. SD are associated with mental and physical wellbeing and with relationship satisfaction, yet they are rarely discussed with medical professionals who are often ill equipped to assess and manage them. This paper provides an updated overview on the status of SD in Australian men from 18 to 55 years of age and will form a baseline comparison for future analyses of SD based on Ten to Men data. Methods We used data from Ten to Men, the Australian Longitudinal Study on Male Health. SD was measured using eight items capturing specific sexual difficulties. We examined associations of a range of health and lifestyle factors (smoking, alcohol consumption, illicit drug use, obesity and new sexual partners, self-rated health status, disability, pain medication, diagnosed physical and mental health conditions) with each SD using logistic regression. The sample included 12,636 adult males who had previously been sexually active. Analysis was stratified by age (18–34 years versus 35–55 years). ResultsThis paper shows that experiencing SD is relatively common among Australian men – overall half the sample (54 %; 95 % CI: 0.53–0.55) experienced at least one SD for more than 3 months over the past 12 months. While more common in older men aged 45 to 55 years, almost half the 18 to 24 year old men (48 %) also reported at least one SD highlighting that SD affects men of all ages. We found that SDs were associated with both lifestyle and health factors, although the strongest associations were observed for health factors in both age groups, in particular poor self-rated health, having a disability and at least one mental health condition. Lifestyle factors associated with SDs in men of all ages included smoking, harmful alcohol consumption and drug use in the past 12 months. Obesity was only associated with an increased rate of SD in men aged 35 to 55 years. Conclusion Sexual difficulties are common among men of all ages and increasingly more prevalent as men grow older. They are strongly associated with both health and lifestyle factors. With previous literature showing that SDs can be a precursor of an underlying or developing physical and mental health condition, it is imperative that sexual health and sexual functioning is discussed with a doctor as part of a standard health check and across the lifespan.
... [4][5][6] Specifically, as for men, it can increase the risk of erectile dysfunction. [7,8] As for women, it can increase the risk of developing cervical and breast cancers. [9][10][11][12] A multi-country study focuses on the 15-and 16-year-old adolescents found that the prevalence of smoking is 28% among smokers who smoked stable over the past 4 years. ...
Article
Full-text available
This retrospective study investigated the effect of smoking cessation intervention (SCI) among university students in China. Around 192 eligible smokers among university students were included, and were assigned to an intervention group (n = 100), and a control group (n = 92). All included subjects in both groups were recommended to increase fruits and vegetables consumptions. Additionally, participants in the intervention group also underwent SCI therapy for a total of 4 weeks. The outcome measurements consisted of a number of students quit smoking, daily cigarettes, quit attempts, mean days of smoking in the past 30 days, and also stage of change. After 4-week treatment, SCI neither can decrease the number of students quit smoking (P = .21), daily cigarettes (P = .21), quit attempts (P = .07), and mean days of smoking in past 30 days (P = .77), nor can enhance the stage of change (precontemplation, P = .18; contemplation, P = .59; preparation, P = .46). The results of this study showed that after 4-week therapy, SCI may be ineffective for smokers among university students in Chinese.
... 32 Similarly, Mialon et al. surveyed over 3,800 Swiss army men aged 18-25 and found a link between ED and depression. 33 In both of these studies, however, it was unclear if the ED caused the depression or vice versa. It is likely a bidirectional relationship. ...
... Estimated prevalence rates of erectile dysfunction among men in the United States are about 22%, 1 and reported rates of premature ejaculation range from 17%e30%. 2 Given that impaired male sexual function is associated with low selfesteem, mood disorders, relationship difficulties, and general well-being, 3,4 it is important to understand the causes and maintaining factors of impaired sexual function to develop and improve efficacious treatments. ...
Article
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Introduction: According to theoretical models of sexual dysfunction, the complex association between male sexual function and subjective sexual well-being (ie, sexual satisfaction and distress) may be partially mediated by specific "consequences" of impaired function, but little research has assessed the frequency of specific consequences or their association with well-being. Aim: To pilot a scale assessing consequences of impaired male sexual function, and test whether specific consequences (eg, disruption of sexual activity, negative partner responses) mediated the association between sexual function and well-being. Methods: 166 men in sexually active heterosexual relationships completed self-report measures. A majority of men self-identified as experiencing impaired sexual function in the past month. Main outcome measure: Sexual Satisfaction Scale, International Index of Erectile Function, and Measure of Sexual Consequences. Results: 17 specific consequences were reported with at least moderate frequency and were rated at least somewhat distressing. A factor analysis suggested 3 distinct categories of consequences: barrier to sex and pleasure, negative partner emotional responses, and impaired partner sexual function. These factors and the overall scale exhibited acceptable internal and test-retest reliability and each was significantly associated with multiple facets of sexual function and well-being. Frequency of sexual consequences significantly mediated the association between sexual function and well-being, with the strongest and most consistent indirect effects being found for the barrier to sex and pleasure factor. Clinical implications: Consequences of impaired sexual function on one's sexual experiences may be an important maintaining factor of sexual dysfunction and reduction in these consequences may represent a mechanism of action for psychological treatments. Strength and limitations: Strengths included a relatively large sample with a diverse range of sexual function and well-being, as well as modern statistical analyses to assess factor structure and mediation effects. Limitations included the use of self-report scales with limited independent evidence of validity and reliability for use with male samples, as well as the cross-sectional methods that preclude strong conclusions regarding causal relationships. Conclusion: Sexual consequences represent potential maintaining factors of male sexual dysfunction and may represent key targets of cognitive behavioral treatments. Stephenson KR, Truong L, Shimazu L. Why is impaired sexual function distressing to men? Consequences of impaired male sexual function and their associations with sexual well-being. J Sex Med 2018;15:1336-1349.
... and 0.99 (95% CI: 0.80-1. 22; I 2 = 81.4%), respectively (Fig. 3a, b). ...
Article
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The purpose of the present study was to conduct a meta-analysis of cross-sectional studies assessing the relationship between alcohol consumption and the risk of erectile dysfunction (ED). To identify relevant studies, databases such as Pubmed, Medline, Embase, and the Cochrane Library were searched from the inception of the present study to March 2016. Finally, 24 studies (154,295 patients) were included. We combined a study-specific odds ratio (OR) estimated by using a random effects meta-analysis. The results of our meta-analysis indicated that light to moderate alcohol consumption (<21 drinks/week) was correlated with a decreased risk of erectile dysfunction (OR = 0.71; 95% CI: 0.59–0.86; P = 0.000). However, regular (ever vs. never) and high alcohol consumption (>21 drinks/week) had no significant influence on the prevalence of ED (regular: OR = 0.87; 95% CI: 0.75–1.07; P = 0.062; high: OR = 0.99; 95% CI: 0.80–1.22; P = 0.893). In a dose–response meta-analysis, a non-linear relationship was observed between alcohol consumption and risk of ED (P for non-linearity = 0.0000). In conclusion, moderate intake of alcohol exhibited a beneficial effect on the risk of ED, whereas regular and high consumption did not.
... We know that a considerable proportion of young male population access Internet for pornography consumption [24,25]; in fact, it is one of their key sources for sexual health [26]. Some have expressed concern about this, addressing the time gap between when porn material is consumed for the first time ever, and an actual first sexual experience; specifically, how the former can have an impact on sexual development [27] like abnormally low sexual desire when consuming online pornography [28] and erectile dysfunction, which has spiked dramatically among young men in the past few years when compared to a couple decades ago [29][30][31][32][33]. ...
Article
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In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. Common problems include: sample bias, the search for diagnostic instrumentals, opposing approximations to the matter, and the fact that this entity may be encompassed inside a greater pathology (i.e., sex addiction) that may present itself with very diverse symptomatology. Behavioral addictions form a largely unexplored field of study, and usually exhibit a problematic consumption model: loss of control, impairment, and risky use. Hypersexual disorder fits this model and may be composed of several sexual behaviors, like problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction considering the "triple A" influence (accessibility, affordability, anonymity). This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research.
... Both the high prevalence of erectile dysfunction and male pornography use noted in our study are consistent with the reported rates in the literature, 18-30% and 36-75% respectively. 1,2,4,16,17 Rates appear higher in younger age groups with studies targeting college age and young adult men demonstrating 86% use. 18 These prevalence rates have to be viewed with an appreciation for the inherent methodologic shortcomings and potential biases of cited studies. ...
Article
Introduction We aimed to explore and describe the pornography habits of young men and women. Given recent upward trends in pornography use and erectile dysfunction, along with a plausible pathophysiology, we hypothesized that pornography use would correlate with sexual dysfunction. Materials and Methods Institutional Review Board approval was obtained. Surveys were distributed to 20–40 year old men and women presenting to a urology clinic. Information was collected on demographics and medical history. Sexual function was evaluated with the International Index of Erectile Function (IIEF) in men and the Female Sexual Function Index in women. Extent of potential addiction to pornography was measured with the pornography craving questionnaire and the obsessive passion scale. Pornography use was measured based on both frequency and duration, and analyzed relative to sexual dysfunction. Results Men used pornography significantly more frequently than women (81.1% vs. 39%). Computer and cellular phone image viewing were the most popular modalities in both sexes. There was no association between IIEF and craving for, or obsessive passion for, pornography. Preference for pornography with masturbation was found to be significantly associated with erectile dysfunction (p = 0.001). Rates of erectile dysfunction were lowest in those preferring partnered sex without pornography (22.3%) and increased significantly when pornography was preferred over partnered sex (78%). No correlation was found between any variables and female sexual dysfunction. Conclusions Pornography and sexual dysfunction are common among young people. No clear relationship exists between extent of addiction to pornography and sexual dysfunction in either gender. However, men who prefer masturbation with pornography to partnered sex have a significantly increased risk of sexual dysfunction. Given sexual dysfunction may be associated with mental health concerns, further evaluation of its causes and impact on military operational readiness are warranted.
... Conversely, previous surveys showed that mental disorders were independently associated with sexual function among young individuals. 21 Likewise, in a previous study conducted on ED patients <40 years, Pozzi et al 9 observed a linear association between BDI scores suggestive for depression and a worsening EF status. These findings have been confirmed in the current study, showing that younger patients have a 2-fold higher risk of presenting EDassociated depressive symptoms compared with older patients with the same ED severity (every category). ...
Article
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Introduction The impact of erectile dysfunction (ED) on patients’ sexual satisfaction and mood profile could differ across different ages. Aim To investigate the relationship between erectile function (EF), sexual satisfaction, and mood status among patients seeking medical help for ED. Methods Data from 765 patients presenting at a single center for ED were analyzed. Patients were categorized as young (≤50 years), middle-aged (>50 and ≤65 years), and old (>65 years) individuals and completed the International Index of Erectile Function (IIEF) and the Beck’s Inventory for Depression (BDI). Main Outcome Measures The IIEF overall satisfaction and intercourse satisfaction domain scores and the BDI score were used to investigate sexual life satisfaction and depressive symptoms (defined as BDI > 11) across ages and according to ED severity. Linear and logistic regression analyses assessed the relationship between satisfaction scores and the risk of depressive symptoms with age and EF. Results Median (interquartile range) age at first assessment for ED was 50 (38, 59) years. Compared with older men, young and middle-aged patients showed significantly higher IIEF-OS and IIEF– Intercourse Satisfaction scores for increasing IIEF-EF scores. Older men showed no difference in terms of satisfaction scores for mild ED and normal EF status. At linear regression analysis, both IIEF-EF and age were significantly associated with sexual satisfaction (all P < .0001). The interaction term between age and EF was also significant, suggesting that the older the patients, the higher the feeling of sexual satisfaction for the same EF status (P = .004). Overall, 25% of patients reported depressive symptoms. Logistic regression analysis showed a 40% risk of depressive symptoms for patients <45 years with severe ED compared to a risk <20% for a man >65 years of age with the same EF status. Clinical Implications Treating older patients with mild ED may not lead to a further improvement in sexual satisfaction as compared with younger patients with the same ED severity. Younger ED patients suffer more from depressive symptoms compared with older men, regardless of ED severity, thus supporting the need for a comprehensive psychological counseling. Strength & Limitations The single-center design and the lack of the assessment of the impact of ED treatment are the main limits. Conclusions The clinical management of ED should be tailored according to different ages: younger patients deserve to be investigated and eventually treated for depressive symptoms. Older patients should be counseled for treatment when a sexual satisfaction improvement is expected. Capogrosso P, Ventimiglia E, Boeri L, et al. Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages? J Sex Med 2019;16:999–1004.
... For example, the claim that porn addiction results in erectile dysfunction ignores the research that shows it is actually quite common, occurring in up to 30% of men under age 40, and has many underlying causes (Capogrosso et al. 2013). Erectile dysfunction in young men is better explained as a result of anxiety, inexperience, or simply a normal aspect of the range of sexual functioning (Mialon et al. 2012). ...
... Caskurlu et al [6] investigated the aetiology of ED across different age groups and found that 85.2% of 526 men younger than 40 yr had psychogenic ED as their primary aetiology. Similarly, in a Swiss population of men aged 18-25 yr, mental health emerged as an independent predictor of impaired sexual function regardless of medications used and physical health [17]. Beside psychogenic factors such as performance anxiety, strained relationships, and lack of sexual arousability, overt psychiatric conditions have been strongly associated with severe ED. ...
Article
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Background: Erectile dysfunction (ED) is an increasingly common complaint among men aged <40 yr. Objective: To assess clinical factors potentially associated with impaired erectile function (EF) in a cohort of young men seeking first medical help for ED as their primary complaint. Design, setting, and participants: Complete sociodemographic and clinical data for 307 consecutive patients aged <40 yr were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. Patients completed the International Index of Erectile Function (IIEF) and Beck's Inventory for Depression (BDI) and were categorised into two groups: those with impaired EF (IIEF-EF <26) and those with normal IIEF-EF scores. Outcome measurements and statistical analysis: Descriptive statistics and logistic regression analyses were used to test the association between risk factors and impaired EF. Results and limitations: Overall, 78 patients (25%) had normal and 229 (75%) had impaired IIEF-EF scores. Among ED patients, 90 (29%) had IIEF-EF scores suggestive of severe ED. The two cohorts did not differ in terms of median age, body mass index, prevalence of hypertension, general health status, smoking history, or alcohol use. No differences were reported for serum sex hormones and lipid profiles. Patients with ED reported higher median BDI scores (7, interquartile range [IQR] 3-13) than those with normal EF (5, IQR 1-9). Overall, the higher the BDI score, the lower was the IIEF-EF domain score (odds ratio 1.08, 95% confidence interval 1.02-1.15; p=0.01). The single-centre cohort is the main study limitation. Conclusions: Overall, young men with impaired EF showed comparable clinical characteristics to those with normal IIEF-EF; conversely, young individuals with worse EF had BDI scores suggestive of significant mood deflection. Patient summary: Young men complaining of erectile dysfunction show significant mood deflection in comparison to patients with normal erectile function. Conversely, the clinical characteristics are similar between the two groups.
... As presented in Figure 1, the searches yielded 452 nonduplicated articles. After excluding 421 articles based on title/abstract review, 31 articles were retrieved for full text review and 5 articles (Aldemir et al., 2017;Aversa et al., 2008;Elbendary et al, 2009;Kumsar et al., 2016;Mialon et al., 2012) were included in the qualitative/ quantitative synthesis. ...
Article
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Globally, there is increasing usage and legalization of cannabis. In addition to its reported therapeutic effects, cannabis has several health risks which are not clearly defined. Erectile dysfunction (ED) is the most common male sexual disorder and there are plausible mechanisms linking cannabis use to ED. No attempt has been made to collate the literature on this topic. The aim of this review was to summarize the prevalence and risk of ED in cannabis users compared to controls. A systematic review of major databases from inception to January 1, 2019, without language restriction, was undertaken to identify studies investigating cannabis use and presence of ED. The analysis compared the prevalence of ED in cannabis users versus controls. Consequently, the odds ratio (OR) with 95% confidence intervals (CI) was calculated, applying a random-effect model. Five case–control studies were included with data from 3,395 healthy men, 1,035 using cannabis (smoking) and 2,360 nonusers. The overall prevalence of ED in cannabis users was 69.1% (95% CI: 38.0–89.1), whilst the correspondent figure in controls was 34.7% (95% CI: 20.3–52.7). The OR of ED in cannabis users was almost four times that of controls (OR = 3.83; 95% CI: 1.30–11.28; p = .02), even if characterized by high heterogeneity ( I ² = 90%) and the prediction intervals overlapped 1.00 (95% CI: 0.35–7.26). Data suggest that ED is twice as high in cannabis users compared to controls. Future longitudinal research is needed to confirm/refute this and explore if a dose–response relationship between cannabis and ED may be evident.
... Similarly, same effects have been reported in other study settings. 58,59 One of the study among 1,159 amphetamine-only drug users showed that amphetamine users had 2 times higher odds to develop ED compared to nonusers. 19 Effects of amphetamine usage vary, depending on its dosage, quantity, and route of administration. ...
Article
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Background Erectile dysfunction (ED) is a common problem among men across the world. It is usually multifactorial in origin. Behavioral factors can be related to the development of ED and related to many other chronic diseases. It impacts not only the sexual function but also the psychology and their overall quality of life. Aim To determine the association of the behavior factors in relation to ED and to identify the risk and protective factors. Method A systematic review search based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted. The primary databases PubMed, PlosOne, Oxford Academic, SCOPUS, and Ovid were accessed using specific keyword searches. Quality of articles was assessed by using Newcastle-Ottawa Assessment Scale according to the study design. Outcome Evaluation of the relationship between behavioral factors and ED. Results 24 studies were identified from the 5 databases which met the predetermined criteria. Overall, the study population include adult male age between 18 and 80 years. The sample size of the studies ranges from 101 to the largest sample size of 51,329. Smoking, alcohol, and drugs usage are found to be risk factors for ED. Meanwhile, dietary intake, physical activity, and intimacy are the protective factors for ED. Clinical Implication The findings from this review may aid clinicians to aim for early detection of ED by screening their risk factors and providing early treatment. This can also be used to promote awareness to the community on the sexual health and factors that can affect their sexual function. Strength & Limitation This study looks at all types of behavioral factors that may affect ED; however, there was a substantial heterogeneity detected across the selected study factors. Furthermore, the lack of PROSPERO registration is also a limitation in this study. Conclusion Overall, smoking, dietary intake, alcohol consumption, drugs, and physical activities are modifiable risk factors for ED in men. Therefore, it is crucial to promote healthy lifestyle and empower men to prevent ED and early detection of ED for early treatment. Sivaratnam L, Selimin DS, Abd Ghani SR, et al. Behavior-Related Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2020;XX:XXX–XXX.
... This is further supported by an exceptionally high prevalence of ED in younger men. For example, a study using the IIEF-5 showed that Swiss men aged 18-25 years displayed a prevalence of 30% [Mialon et al., 2012]. Another IIEF-based study demonstrated that ED prevalence in a population in India ranged from 9.9 to 13% in 18-40-years-old men [Sathyanarayana Rao et al., 2015]. ...
Article
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Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of erectile tissues in the penis and/or disruptions in adulthood that impact sexual stimuli, neural pathways, molecular changes, and endocrine signalling that are required to drive erection. Sexual stimulation activates the parasympathetic system which causes nerve terminals in the penis to release nitric oxide (NO). As a result, the penile blood vessels dilate, allowing the penis to engorge with blood. This expansion subsequently compresses the veins surrounding the erectile tissue, restricting venous outflow. As a result, the blood pressure localised in the penis increases dramatically to produce a rigid erection, a process known as tumescence. The sympathetic pathway releases noradrenaline (NA) which causes detumescence: the reversion of the penis to the flaccid state. Androgen signalling is critical for erectile function through its role in penis development and in regulating the physiological processes driving erection in the adult. Interestingly, estrogen signalling is also implicated in penis development and potentially in processes which regulate erectile function during adulthood. Given that endocrine signalling has a prominent role in erectile function, it is likely that exposure to endocrine disrupting chemicals (EDCs) is a risk factor for ED, although this is an under-researched field. Thus, our review provides a detailed description of the underlying biology of erectile function with a focus on the role of endocrine signalling, exploring the potential link between EDCs and ED based on animal and human studies.
... For instance, in a preliminary report, one-third of Swiss young men suffered from sexual dysfunction associated with pornography usage. 5 Furthermore, viewing pornography can have adverse effects on normal mental functioning by decreasing the ability to work memory. 6 The viewing of pornography has also been correlated with increased sexual violence. ...
Article
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Background There has been a tangible increase in pornography consumption during the past decade, with the absence of a large-scale study of Arab countries. Aim The present study aimed to assess the prevalence of pornography viewing and its associated risk factors in Arab countries. Methods A large cross-sectional online survey was carried out recruiting participants without restrictions on the age, socioeconomic level, job, or educational level. Multivariable logistic regression analysis was performed to identify possible risk factors for viewing porn and results were expressed as odds ratios (ORs) and 95% confidence interval (95% CI). Outcomes Main outcomes were pornography viewing (first exposure and frequency), the perceptions of this act, use of spare time, physical activity (exercising), and frequency of psychiatrist visits. Results The final number of participants included in the study was 15027 participants with a mean age ± standard deviation of 23.82 years ± 24.99. Most of the participants were men (84.56%), living with parents (81.71%), and 60.51% university graduates. There were statistically significant differences (P < .001) in the attitude and practice of men compared with women throughout all tested variables. Frequent pornography viewing was associated with male gender (OR [95% CI] = 7.08 [6.43 to 7.81]; P < .001) and age group ≤15 years (OR [95% CI] = 1.33 [1.01 to 1.75]; P = .044). By contrast, higher education was inversely associated with viewing rates reaching the lowest level in PhD awardees (OR [95% CI] = 0.36 [0.26 to 0.51]; P = .003). It was also noted that regular exercising (OR [95% CI] = 0.66 [0.58 to 0.74]; P < .001) was associated with a reduction in pornography viewing rates. Clinical implications Young age, male gender, and lower educational level are all predictors for higher pornography viewing and should be considered when designing public health intervention in a related context. Strengths and limitations This is the first large-scale multi-national survey to be conducted in Arab countries to investigate pornography viewing. The main limitations were the cross-sectional design (cannot indicate causality) and the self-report nature (liable to social desirability and recall bias). Conclusion Pornography viewing is common in Arab countries and associated with some personal and behavioral factors. MA Eljawad, H Se'eda, S Ghozy, et al. Pornography Use Prevalence and Associated Factors in Arab Countries: A Multinational Cross-Sectional Study of 15,027 Individuals. J Sex Med 2020;XX:XXX–XXX.
... Between 50% and 70% of adult men use pornography on a regular basis, and for adolescent lifetime use, the numbers are even higher than 80% [13,14]. Simultaneously, the reported prevalence of ED in young men has increased enormously over the last decades, from 2%-5% in 1999 and 2002 to 20%-30% in more recent reports [15][16][17][18]. ...
Preprint
BACKGROUND Expanding access to the internet resulted in more and earlier consumption of online pornography. At the same time, a higher prevalence of erectile dysfunction (ED) among young men is seen. Increased pornography consumption has been suggested as a possible explanation of this rise. OBJECTIVE The aim of this study is to better understand associations between problematic pornography con-sumption (PPC) and ED. METHODS A 118-item survey was published online and data collection took place between April 2019 and May 2020. 5770 men responded. Eventually, the results of 3419 men be-tween 18 and 35 years old were analyzed. The survey used validated questionnaires like Cyber Pornography Addiction Test (CYPAT), IIEF-5, and AUDIT-c. Estimated amount of porn watching was calculated. Univariable and multivariable analyses were performed. For the multivariable analysis a logistic regression model using a directed acyclic graph (DAG) was used. RESULTS According to their IIEF-5 scores, 21,5% of our sexually active participants (i.e. those who attempted penetrative sex in the previous 4 weeks) had some degree of ED. This prevalence of ED in young men is alarmingly high and the results of presented study suggest a significant association with PPC. CONCLUSIONS Higher CYPAT scores indicating problematic online pornography consumptium resulted in a higher probability of ED, while controlling for covariates. Masturbation frequency seemed not a significant factor when assessing ED. CLINICALTRIAL The study was registered on www.researchregistry.com (ID 5111).
... ED: Using the recommended cut off score of ≤21, 55 the majority of men (72%) had no erection problems, however similar to other studies a total of 27.4% indicated mild ED or worse. 41,47,50 One way ANOVA demonstrated that men who were single had reduced erectile function to men who were in a ...
Article
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Introduction The way men consume pornography changed over the last decade, with increased numbers of men presenting with self-perceived Internet pornography (IP) addiction and related sexual dysfunction. A lack of consensus and formal recognition in the DSM-5 lead to a variety of definitions of IP addiction. Currently, the majority of evidence linking IP addiction and sexual dysfunction was derived from consumers, case studies, and qualitative research. Where empirical measures were used, researchers found mixed outcomes in sexual response. Inconclusive data appeared to relate to the conflation of IP use and self-perceived IP addiction, and normal variations in sexual response with clinical diagnosis of sexual dysfunction. Thus, further empirical clarification is required to assess the impact of both IP use and self-perceived IP addiction, on men's sexual function. Aims This study has 3 aims: First, to assess if there is an association between IP use alone and erectile dysfunction (ED), premature (early) ejaculation (EE) and sexual satisfaction (SS); Second, to assess whether there is an association between self-perceived IP addiction and ED, EE and SS. Third, to assess whether IP use or self-perceived IP addiction uniquely predicts ED, EE, SS in men. Method Correlation and regression analysis was conducted on a cross-sectional sample of 942 heterosexual men aged 18-44 years who participated in an online survey sourced from Reddit IP subgroups. Main Outcome Measures Cyber-Pornography Use Inventory; International Index Erectile Dysfunction; The Checklist for Early Ejaculation Symptoms; New Sexual Satisfaction Scale; Depression Anxiety Stress Scale-21. Results There was no evidence for an association between IP use with ED, EE, or SS. However, there were small to moderate positive correlations between self-perceived IP addiction and ED, EE and sexual dissatisfaction. Further, self-perceived IP addiction uniquely predicted increased ED, EE and individual sexual dissatisfaction. Contrary to expectations, self-perceived IP addiction did not predict sexual dissatisfaction with one's sexual partner. Conclusion These results suggest that IP use alone does not predict sexual dysfunction. Rather, self-perception of increased IP addiction was related to negative sexual outcomes. Thus, we concluded that subjective interpretation of ones IP use was a contributor to IP related sexual problems in our sample of males who share IP on social media sites. We recommend that clinicians consider self-perceived IP addiction as a possible contributing factor to sexual dysfunction. Whelan G, Brown J. Pornography Addiction: An Exploration of the Association Between Perceived Addiction, Erectile Dysfunction, Premature (Early) Ejaculation, and Sexual Satisfaction in Males Aged 18-44 Years. J Sex Med 2021;XX:XXX–XXX.
... Between 50% and 70% of adult men use pornography on a regular basis, and for adolescent lifetime use, the numbers are even higher than 80% [13,14]. Simultaneously, the reported prevalence of ED in young men has increased enormously over the last decades, from 2%-5% in 1999 and 2002 to 20%-30% in more recent reports [15][16][17][18]. ...
Article
Full-text available
Background: Expanding access to the internet resulted in more and earlier consumption of online pornography. At the same time, a higher prevalence of erectile dysfunction (ED) among young men is seen. Increased pornography consumption has been suggested as a possible explanation of this rise. Objective: The aim of this study is to better understand associations between problematic pornography consumption (PPC) and ED. Methods: A 118-item survey was published online and data collection took place between April 2019 and May 2020. 5770 men responded. Eventually, the results of 3419 men between 18 and 35 years old were analyzed. The survey used validated questionnaires like Cyber Pornography Addiction Test (CYPAT), IIEF-5, and AUDIT-c. Estimated amount of porn watching was calculated. Univariable and multivariable analyses were performed. For the multivariable analysis a logistic regression model using a directed acyclic graph (DAG) was used. Results: According to their IIEF-5 scores, 21,5% of our sexually active participants (i.e. those who attempted penetrative sex in the previous 4 weeks) had some degree of ED. Higher CYPAT scores indicating problematic online pornography consumption resulted in a higher probability of ED, while controlling for covariates. Masturbation frequency seemed not a significant factor when assessing ED. Conclusions: This prevalence of ED in young men is alarmingly high and the results of presented study suggest a significant association with PPC. Clinicaltrial: The study was registered on www.researchregistry.com (ID 5111).
... Malefactor infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male reproduc tive tract, which prevents the conception of a child (American Society for Reproductive Medicine [ASRM], 2020). ED and premature ejaculation are the most com mon sexual dysfunctions (Hatzimouratidis, 2007;McCabe et al., 2016;Mialon et al., 2012;Papaharitou et al., 2006) and may contribute to infertility in some instances. ...
Article
Full-text available
Erectile dysfunction (ED) is a common, burdensome, and costly urologic condition strongly related to all aspects of general health, from physical to mental. ED has profound consequences as it may interfere physical well-being, quality of life (QoL), self-esteem, relationships, self-worth, and productivity. It is therefore important to ensure that all types of effective ED treatments are consistently accessible to patients. While federal and state mandates ensure access to treatment for women’s breast health, female-factor infertility, and gender affirmation to ensure that these individuals do not experience a diminished QoL, there are no comparable mandates for men’s sexual and reproductive health. The burden of ED necessitates a call to action to improve the accessibility of ED treatments. The call to action steps include: (a) coverage for pharmacological, surgical, and other ED treatments should be viewed in the same way as coverage for other health issues, whether male or female and regardless of the stages of treatment, physical dysfunction, or physical changes; (b) American Urological Association (AUA) guidelines for the management of ED should be followed, including implementation of templates in electronic medical records (EMRs) to support adherence to the guidelines; and (c) coverage criteria should explicitly state that the criteria are intended to support gender equity for sexual and reproductive health care and should not be used to prevent men from receiving medically necessary ED treatments. This call to action offers a pathway to support every man who seeks treatment for ED as a medically necessary intervention by removing systemic health-care barriers.
... 73 In fact, the etiology of ED, even in younger men, is mostly multifactorial, including a combination of psychological and biological factors. 74,75 Other important factors to be considered are ED onset primary (ie, present from the very first sexual contact) or secondary (ie, developed after a period of healthy sexual function) and if ED occurs in all situations or in specific ones. Adding specificity to the diagnosis of ED is important in order to develop more personalized treatment plans. ...
Article
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Introduction Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far. Aim To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM). Method A comprehensive, narrative review of the literature was performed. Main outcome measures Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided. Results A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable. Conclusion Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect. Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;XX:XXXXXX.
... In a survey of 2,507 Swiss men aged between 18 and 25 years, Mialon et al found that there was no association between cannabis use and ED in a bivariate analysis. 18 However, the age of the population may limit the prevalence of sexual dysfunction. In contrast, Elbendary et al found that adult drug use, which mostly consisted of cannabis use in their cohort, was associated with increased odds of ED in multivariable analysis. ...
Article
Full-text available
Introduction: Cannabis is the most commonly used drug in the United States; however, the effects of cannabis use on male sexual function are poorly understood. Aim: To characterize the contemporary landscape of cannabis use and to assess the associations between male sexual function and the frequency of use, the primary method of consumption, or cannabis chemovar (tetrahydrocannabinol or cannabidiol) among current users. Methods: We surveyed adults who visited a single cannabis dispensary for baseline demographic information, medical history, cannabis use habits, and sexual function as assessed by the International Index of Erectile Function (IIEF). An IIEF-5 < 21 was considered erectile dysfunction. Main outcome measures: The main outcome measure of the study was male sexual function via the IIEF domain scores. Results: A total of 325 men completed the survey with a mean age of 46.7 years. 71.1% of the men were Caucasian and 52.6% were married. 13 men (4%) were never users; 29 men (8.9%) used 1-2 times/week; 51 men (15.7%) used 3-5 times/week, and 232 men (71.4%) used 6+ times/week. The average IIEF-5 score was 22.3 with 19.4% of the men having erectile dysfunction. In univariate analysis, men using cannabis more frequently had a higher overall IIEF (65.36 vs 60.52, P = .001), erectile domain (27.32 vs 25.74, P = .03), orgasm domain (9.08 vs 8.12, P < .001), intercourse satisfaction domain (12.42 vs 11.31, P = .006), and overall satisfaction domain (8.11 vs 7.05, P = .002). In multivariable analysis, compared to men who used cannabis 0 times/week, those who used 6 times/week had an increased overall IIEF (69.08 vs 64.64, P-value adjusted = 0.02), intercourse satisfaction domain (P-value adjusted = 0.04), and overall satisfaction domain (P-value adjusted = 0.02). The primary method of consumption (eg, smoking, edibles, etc.) and cannabinoid composition (eg, cannabidiol vs tetrahydrocannabinol dominant) were not associated with sexual function. Conclusion: We report an association between the increased frequency of cannabis use and increased male sexual function. However, while the increased frequency of use was statistically significant with regard to the IIEF scores, the clinical significance of this is likely low, and selection bias may limit the generalizability of these findings. The method of consumption and cannabis chemovar were not associated with sexual function. Bhambhvani HP, Kasman AM, Wilson-King G, et al. A Survey Exploring the Relationship Between Cannabis Use Characteristics and Sexual Function in Men. J Sex Med 2020;8:436-445.
... 5 In addition, sexual dysfunctions can themselves impact mental health. 10 Scientific data on the prevalence of sexual dysfunctions in psychiatric population are reported in different literature reviews and clinical textbooks. They show associations between sexual dysfunctions and depression, anxiety, psychosis, eating, and personality disorders. ...
Article
Background The scientific literature on sexuality among mentally ill patients clearly shows a higher prevalence of sexual disorders for many mental disorders, but little is known about sexuality in individuals suffering from ADHD. Clinicians will often assume that specific difficulties of ADHD are bound to affect sexual functioning. Aim The aim of this study was to provide a review of the literature to gain better knowledge about sexuality in subjects with ADHD and to discuss screening and management of their potential sexual problems. Methods A systematic review of the literature was performed in Pubmed, PsychInfo, and Embase databases. Main Outcome Measures The main outcome measures were sexual function and sexual dysfunctions. Results The studies indicated that subjects with ADHD report more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population. Clinical Implications Clinicians working with subjects with ADHD should explore the quality of their sexual life. Strengths & Limitations This is the first systematic review of the sexuality of individuals with ADHD. However, the results are limited by the small number of studies, by the small sample size of many studies, and the potential for bias. Conclusions ADHD is a mental disorder affecting sexual health. Further studies are warranted to learn more about sexuality in subjects with ADHD. Soldati L, Bianchi-Demicheli F, Schockaert P, et al. Sexual Function, Sexual Dysfunctions, and ADHD: A Systematic Literature Review. J Sex Med 2020;XX:XXX–XXX.
... Increased intromission was observed in morphinetreated rats as an inhibitor effect of opioids on sexual reflexes (59). In human beings like tramadol, opioids could affect male fertility when used as a painkiller or to cure premature ejaculation. ...
Article
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Illicit drug use is growing among young people, which is one of the major problems in today's society that can be associated with many medical issues, including infertility. Amphetamines, cocaine, opioids, and marijuana are the most common and the most used illicit drugs worldwide. The purpose of this review was to collect as much literature as possible about the impact of illicit drugs on male fertility and summarize their valuable data. Original studies and reviews were collected by searching the keywords "illicit drugs (all kinds of that) and male infertility". The obtained information was also categorized based on the content of the "Infertility in the Male" book. Almost all studies suggested that taking all kinds of illicit drugs with the effects on different parts of the male reproductive system can result in subfertility or complete infertility in the consumers. Although the data in this field are not decisive and there are some confounding factors in human studies, it can be inferred that the use of any illicit drug with an effect on male sexual health reduces fertility potency. Therefore, it is recommended that couples, who are planning to conceive, avoid taking any illicit drugs before and during treatment.
Article
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Background and objectivesRegardless of the disease states that people suffer from, maintaining sexual function is an important indicator of quality of life. The objective of this review was to figure out the relationship between epilepsy, antiepileptic drugs (AEDs) and sexual dysfunction. ResultsIn various epidemiological and clinical studies, epilepsy has been correlated with a reduction in sexual function. This sexual dysfunction is not always detected in epileptic patients until systematic efforts are put in place, as part of the assessment and treatment process. Therefore, precise evaluations of the incidence of treatment related sexual dysfunction in epileptic patients is still lacking. Conclusions This literature review concluded that sexual function is influenced by the pathophysiology of epilepsy, as well as through the use of AEDs. To maximize quality of care in patients with epilepsy and those patients with other disease states who receive AEDs, it is important to address the status of the patient’s sexual function as part of the initial routine assessment and with any treatment related follow-up. Minimizing the effects of AED related sexual dysfunction can be achieved by raising awareness among patients, providing education and training for physicians regarding sexual dysfunction and obtaining a baseline sexual history from the patient so are important recommendations. In addition, systematic studies are needed to explore the risk and mechanism of such treatment related side effects on sexual function.
Article
Premature ejaculation (PE) is a commonly reported sexual dysfunction in men and yet research remains scarce when looking at the psychopathological mechanisms involved in PE. This study aimed to establish whether depression, anxiety and sexual fantasy mediated the relationship between sexual self- efficacy and PE. Sixty British participants with and without PE aged between 18 and 50 years took part in an online cross-sectional survey consisting of questionnaires measuring PE, sexual self-efficacy, sexual fantasy, depression, anxiety and demographic information. The total and direct effects of sexual self- efficacy on PE were significant. Further, anxiety mediated the relationship between PE and sexual self-efficacy. However, depression and sexual fantasy did not mediate the relationship between these variables. Higher levels of depression, anxiety, and lower levels of sexual self-efficacy were reported among the PE group than the non-PE group. Sexual fantasies further differed between PE and non-PE groups where ‘self-derogatory’ sexual fantasies such as “embarrassment due to failure of a sex act” were commonly reported among the PE group. The preliminary findings from this pilot study suggest the possible use of performance anxiety reduction techniques in the treatment of PE.
Chapter
Sexual dysfunction is a very common problem that affects many women in their lifetime. Female sexual dysfunction is a complex multifactor phenomenon that covers a range of sexual problems including sexual desire, sexual arousal, orgasm, or sexual pain disorders. Each one has distinct symptoms that are negatively regulated by drug abuse (i.e., cocaine and heroin, but also antidepressants), tobacco, and alcohol; however, some drugs have been found to make sexual problems worse, others milder. The pharmacological mechanisms associated to female sexual disorders promoted by drugs are unfortunately only partially elucidated. Moreover, the levels of several physiological neurotransmitters, as serotonin or dopamine, or vascular factors, as nitric oxide, seem to contribute to female sexual disorders and are modulated by drugs as antidepressants or by toxic compounds as tobacco. In addition, women have pharmacokinetic and pharmacodynamic characteristics that are different from men and that increase drug side effects respect to men. Further studies are thus necessary to better understanding the impact of alcohol and drug abuse on female sexual dysfunction.
Chapter
Chronic neurological disease can have a tremendous impact on a woman’s health, self-image, and consequently on self-esteem [1]. One of the most important areas that could be impaired after the onset of a neurological disease is sexual function.
Article
Resumen Introducción La eyaculación precoz puede deberse a múltiples factores y uno de ellos puede ser el consumo de drogas. Objetivos El objetivo principal de este estudio es conocer cómo afecta el consumo de drogas a la respuesta eyaculatoria, teniendo en cuenta las diferentes sustancias de consumo, el nivel de ansiedad y el tiempo de abstinencia. Método Se utilizaron 2 muestras, una correspondiente a hombres que han tenido un historial de consumo de sustancias adictivas (n = 925) y otra de hombres no consumidores (n = 82). Ambas muestras fueron seleccionadas de 28 centros de tratamiento. Se utilizaron los cuestionarios Golombok Rust Inventory of Sexual Satisfaction (GRISS) y el Cuestionario de Ansiedad Estado Rasgo (STAI). Resultados Los resultados muestran que los hombres con historia de consumo obtienen porcentajes mayores en eyaculación precoz frente a los no consumidores (44,3 > 15,9%) y puntuaciones medias también mayores en ansiedad (estado = 19,83 > 11,89; rasgo = 25,66 > 12,39), siendo dichas diferencias estadísticamente significativas (p = 0,000). Los resultados confirman que el período de abstinencia no mejora la respuesta eyaculatoria y tener pareja no funciona como factor de protección en la eyaculación precoz. Conclusiones Los hombres con historia de consumo de drogas tienen más probabilidad de padecer eyaculación precoz y más ansiedad, que no mejora en el período de abstinencia, lo que incita a pensar que los consumidores de drogas tienen rasgos de personalidad que predisponen la eyaculación precoz y/o que los daños neurológicos ocasionados por la drogas contribuyen a disminuir la latencia intravaginal eyaculatoria, cuestiones que deben ser estudiadas en próximas investigaciones.
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This chapter proposes a narrative understanding of sexual identity and development, and explores the role and implications of this narrative understanding of human sexuality in the context of the therapeutic relationship. The socially constructed nature of narratives of sexuality is examined and critiqued. Clinical case illustrations are provided.
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Introduction: There are no current comprehensive models related to problematic pornography use (PPU) that can directly assist psychological therapists who work with people with these issues. The absence of psychological models results in the therapist being unable to benefit from evidence-based practice and having to work completely idiosyncratically. Methods: A non-systematic narrative review of peer reviewed published research literature related to PPU was undertaken. Results: PPU is introduced with a focus on classification, epidemiology, how it is experienced, causes and associated factors, measurement and treatment. This paper culminates with a preliminary model that attempts to illustrate the main research findings from both this paper and a previous paper written by the authors (Binnie & Reavey, 2019). Recommendations are then made for both practice and research. Conclusions: This review highlights not only what we know so far about PPU but also what we do not know. There are indications from the research literature as to the experience of PPU, but these are lacking; many voices have not been heard. There are indications of developmental factors but no real clarity, and maintenance factors are imprecise. Having an accepted model that helps explain both these factors is essential in developing further research with the ultimate goal of eventually helping people suffering with PPU.
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Pornography addiction and sexual dysfunction are increasingly prevalent in young men. Previous studies suggest that prenatal androgen exposure plays a role in addiction and sexual functionality. Here, we tested whether lower second-to-fourth finger length ratio (2D:4D) and later age at spermarche, both putative indicators of higher androgen levels in utero, correlate with online sexual compulsivity (OSC scale of ISST), erectile function (IIEF-5), and ejaculatory control (PEPA) in 4,370 young men (age IQR: 25–26 years) of the Cohort Study on Substance Use Risk Factors. Statistical analyses revealed that lower 2D:4D correlated with higher scores on the OSC scale. Moreover, higher age at spermarche correlated with higher OSC scores and decreased erectile function. Interestingly, OSC severity, but not the frequency of pornography use, correlated negatively with erectile function and ejaculatory control. This is the first study to associate two independent proxies of prenatal testosterone level with OSC. These findings provide novel insight into intrauterine predisposition of sexual behavior and related sexual function in adulthood.
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Purpose of the Review To review the current state of literature on sexual dysfunction in adults with congenital heart disease (ACHD). Recent Findings The prevalence of sexual dysfunction in ACHD is approximately 28%. Compared to age-matched cohorts, the prevalence of sexual dysfunction among ACHD cohorts demonstrates significant variability. ACHD have a lower rate of ever having sexual intercourse and often at a later age. Regardless of complexity, ACHD with sexual dysfunction have higher level of distress, decreased quality of life, and worse New York Heart Association classification. Patients, including heart failure and ACHD, treated with dual angiotensin receptor neprilysin inhibitor have reported improved sexual relationships. Summary The prevalence of sexual dysfunction in ACHD patients is high and sexual dysfunction research in ACHD remains limited. Therefore, the relationship between sexual dysfunction and ACHD remains ill-defined. Cardiologists that participate in the care of these patients should proactively discuss sexual health and provide counseling and therapies to provide high-quality healthcare for ACHD.
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This qualitative data analysis examined adolescents’ thoughts and feelings about difficulties that can emerge during sexual experiences. The sample consisted of 53 sexually experienced, ethnically diverse, predominantly female, nonpregnant adolescents participating in a web-based sexual health intervention. As part of a message board discussion, adolescents described anxiety-enhancing attitudes and beliefs (e.g., men should be skilled sexually, women should express satisfaction even if they do not feel it). Several adolescents advocated for condom use despite potential difficulties when attempting to use them. Health professionals should equip adolescents with skills to communicate with partners about sexual difficulties and cope with related anxiety.
Article
Background Erectile dysfunction (ED) is a multidimensional sexual disorder that is being increasingly diagnosed in younger men. Although mental illnesses such as depression and anxiety are known risk factors for ED, the association between these conditions and ED has been understudied in young men. Aim To explore the temporal association between depression, anxiety, and ED in a population-based cohort of young men. Methods Using 2009–2018 MarketScan Commercial Claims data, we identified all men with ED aged 18–40 years (cases). Using ICD-9/-10 codes and prescription data, we evaluated the prevalence and incidence of depression and anxiety in this cohort. Cases were matched with men without a diagnosis of ED (controls) based on age, Charlson Comorbidity Index, history of hypertension, geographic region, and year of presentation. We examined the prevalence of depression and anxiety within 12 months prior to ED diagnosis and incidence of depression and anxiety up to 36 months after ED diagnosis in cases vs controls. Differences between cases and controls were tested with Wilcoxon rank-sum test for numerical covariates, and chi-square test for categorical covariates. Significance was set at P < .05. Outcomes Prevalence and incidence of depression and anxiety in young men with and without ED. Results Within the 12-month period preceding ED diagnosis, the prevalence of depression and anxiety in cases vs controls were 17.1% vs 12.9%, respectively (P < .001). The incidence of depression and anxiety were higher amongst cases vs controls at 12- (11.7% vs 6.3%), 24- (14.5% vs 9.0%,) and 36- (15.9% vs 10.6%) months following ED diagnosis (P < .001). Clinical Implications High incidence and prevalence of depression and anxiety in young men diagnosed with ED highlight the importance of normalizing mental health screenings and routine psychiatric follow-up in this population. Strengths & Limitations Our contemporary, case-control study utilizes a population-based cohort of young men with ED to study the temporal association between depression, anxiety, and ED, which is understudied to date. The MarketScan commercial claims database used in this analysis includes men covered by private insurers only and lacks data on symptoms and treatments. Conclusion Young men with ED had significantly higher rates of depression and anxiety both before and after ED diagnosis in comparison to young men without ED. Manalo TA, Biermann HD, Patil DH, et al. The Temporal Association of Depression and Anxiety in Young Men With Erectile Dysfunction. J Sex Med 2021;XX:XXX–XXX.
Article
Condom associated erection problems (CAEP) interfere with the correct and consistent use of condoms. CAEP, a common form of psychogenic erection problems, have been understudied in heterosexual relationships. We conducted a systematic review and qualitative synthesis of all available studies published before 2019 to examine the prevalence, etiology, effects, prevention, and treatment of CAEP in heterosexual men under 40 years of age. 43 full-text articles were assessed; nine met inclusion criteria. Most studies used self-reported questionnaires, some in combination with measures of physiological arousal. The prevalence of CAEP was 18–36%. CAEP involve attentional, affective, behavioural, cognitive, relational, and sensory processes. CAEP were associated with rushed condom application, condom worry/anxiety, distraction, multiple partners, decreased arousal response to sexual stimuli, self-perpetuating dysfunctional sexual learning, decreased penile sensitivity with erections and condoms, issues with condom ‘fit or feel,’ and mental health diagnoses, such as depression, anxiety and ADHD. It is important to address CAEP early with sex-positive approaches targeted at men and women that enhance condom self-efficacy, condom confidence, and sexual communication. Men should practice applying condoms in no pressure (solo-sex) situations to discern the condom that fits and feels best and to develop the ease and confidence to apply condoms for partnered sex with less worry and distraction. Further research is needed to confirm which strategies are most effective at reducing CAEP.
Article
Prior research has shown an increase in individuals living with and suffering from sexual dysfunctions and other sexual-related disorders. A sample of 939 Licensed Professional Counselors (LPC) completed a 30-item questionnaire evaluating the importance, comfort, and actual practice of assessing for a thorough sexual history during an intake session. Results suggest that implementing a thorough sexual history assessment during intakes is warranted. However, many respondents expressed varying levels of discomfort initiating and engaging in these types of discussions with clients. In addition, many respondents reported avoiding the actual practice of initiating a thorough sexual history citing feeling ill-prepared due to counseling programs’ lack of training and preparation.
Article
We analyzed data from the 2018 Sex in Canada survey (n = 1,015 cisgender men) to examine the association between feminist identification and reported use of prescription ED medication (EDM) during men's last sexual encounter. Feminist-identified men were substantially more likely to report EDM use than non-feminist men, even after controlling for alcohol use before sex, erection difficulties, sexual arousal, sexual health, mental health, and physical health. One explanation is that feminist men may use EDM to bolster their masculinity when it is otherwise threatened by their identification as feminist. Another is that non-feminist men may be less likely to use prescription EDM because they view accessing healthcare services as a threat to their masculinity. It is also possible that feminist men are more likely to use EDM because they wish to maintain an erection to better please their partner. Lastly, feminist men may be more honest about EDM use than non-feminist men, even though rates are similar. Regardless of the exact reason, therapists can use these results to tailor sexual health messages to clients based on feminist identification. Future work could employ qualitative methods to understand why feminist men report higher rates of EDM use than non-feminist men.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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Adolescents naturally experience an increased interest in sexual behavior, but they usually lack much experience. Thus, any prescription medication that holds the potential to ease or facilitate sexual matters holds a unique allure. Widespread cultural awareness of medications to treat erectile dysfunction (ED) has combined with a recent trend toward increased adolescent prescription drug abuse to create unique challenges for industry, clinicians, and researchers.Clinical Pharmacology & Therapeutics (2011) 89 1, 22-24. doi: 10.1038/clpt.2010.264
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To analyse the association between body mass index (BMI) and sexual activity, sexual satisfaction, unintended pregnancies, and abortions in obese people and to discuss the implications for public health practices, taking into account the respondents' and their partners' BMI. Random probability survey of sexual behaviours. National population based survey of 12 364 men and women aged 18-69 living in France in 2006. Random selection of 5535 women and 4635 men, of whom 3651 women and 2725 men were normal weight (BMI 18.5-<25), 1010 women and 1488 men were overweight (BMI 25-<30), and 411 women and 350 men were obese (BMI >30). Obese women were less likely than normal weight women to report having a sexual partner in the past 12 months (odds ratio 0.71, 95% confidence interval 0.51 to 0.97). Obese men were less likely than normal weight men to report more than one sexual partner in the same period (0.31, 0.17 to 0.57, P<0.001) and more likely to report erectile dysfunction (2.58, 1.09 to 6.11, P<0.05). Sexual dysfunction was not associated with BMI among women. Obese women aged under 30 were less likely to seek healthcare services for contraception (0.37, 0.18 to 0.76) or to use oral contraceptives (0.34, 0.15 to 0.78). They were also more likely to report an unintended pregnancy (4.26, 2.21 to 8.23). There is a link between BMI and sexual behaviour and adverse sexual health outcomes, with obese women less likely to access contraceptive healthcare services and having more unplanned pregnancies. Prevention of unintended pregnancies among these women is a major reproductive health challenge. Healthcare professionals need to be aware of sensitivities related to weight and gender in the provision of sexual health services.
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Our aim was to identify the barriers young men face to consult a health professional when they encounter sexual dysfunctions and where they turn to, if so, for answers. We conducted an exploratory qualitative research including 12 young men aged 16-20 years old seen in two focus groups. Discussions were triggered through vignettes about sexual dysfunction. Young men preferred not to talk about sexual dysfunction problems with anyone and to solve them alone as it is considered an intimate and embarrassing subject which can negatively impact their masculinity. Confidentiality appeared to be the most important criterion in disclosing an intimate subject to a health professional. Participants raised the problem of males' accessibility to services and lack of reason to consult. Two criteria to address the problem were if it was long-lasting or considered as physical. The Internet was unanimously considered as an initial solution to solve a problem, which could guide them to a face-to-face consultation if necessary. Results suggest that Internet-based tools should be developed to become an easy access door to sexual health services for young men. Wherever they consult and for whatever problem, sexual health must be on the agenda.
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Aim of the study was to evaluate whether endothelial dysfunction is a marker of erectile dysfunction (ED) in recreational drug abuse. Sixty-four non-consecutive men complaining of ED from at least 3 months were included. All patients underwent detailed history about recreational drug abuse and were then submitted to dynamic penile duplex ultrasound (PDU). According to pharmaco-stimulated peak systolic velocity (PSV) cutoff at 35 cm s(-1), patients were divided into two groups: organic (O; n=30) and non-organic (NO; n=34) ED. All subjects and 7 healthy age-matched subjects as controls, underwent veno-occlusive plethysmography (VOP) for the evaluation of endothelium-dependent dilatation of brachial arteries. Blood pressure, total and free testosterone, prolactin, estradiol, low-density lipoprotein and high-density lipoprotein cholesterol were also evaluated; patients were classified with regard to insulin resistance through the HOMA-IR index. Cannabis smoking was more frequent in O-ED vs NO-ED (78% vs 3%, P<0.001) in the absence of any concomitant risk factor or comorbidity for ED. VOP studies revealed impaired endothelium-dependent vasodilatation in O-ED but not in NO-ED and controls (12+/-6 vs 32+/-4 and 34+/-5 ml min(-1), respectively; P=0.003). Overall patients showed a direct relationship between HOMA-IR and PSV (r(2)=0.47, P<0.0001), which was maintained in men with organic ED (r(2)=0.62, P<0.0001). In cannabis consumers, a direct relationship between HOMA-IR and VOP was also found (r(2)=0.74, P<0.0001). Receiver-operating characteristic (ROC) curve analysis revealed that VOP values below 17.22 ml min(-1) were suggestive for vasculogenic ED. We conclude that early endothelial damage may be induced by chronic cannabis use (and endocannabinoid system activation); insulin resistance may be the hallmark of early endothelial dysfunction and may concur to determine vascular ED in the absence of obesity. Further studies are warranted to establish a direct relationship between cannabis abuse, onset of insulin resistance and development of vascular ED.
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A previous survey of letters to 'agony aunts' revealed that adolescents have many concerns about their health. To discover the views of adolescents on a range of issues including the venues where they would like to be seen, the doctors they would like to consult, and the subjects they would like to discuss. A questionnaire was distributed to adolescents in a variety of school settings and distributed through a popular teenage magazine. A total of 525 replies were received. Most adolescents had visited their general practitioner (GP) in the previous year. Most would prefer to see a teenage health specialist at a venue other than their local surgery, and to have the option of a 'drop-in' service. Responders were worried about a wide range of health issues. They had strong opinions on the type of doctor they would like to consult and the style of surgery they would prefer. Concerns were expressed about confidentiality. In the short term, surgeries could be made more 'user-friendly' for adolescents. In the longer term, the authors propose liaison between GPs and paediatricians with a special interest in teenage health to provide a confidential, combined youth service, with ideas on service development based on the expressed wishes of the adolescent population.
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Data from general population surveys (n = 1483 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to cross-validate the selection of questionnaire items for the SF-12 Health Survey and scoring algorithms for 12-item physical and mental component summary measures. In each country, multiple regression methods were used to select 12 SF-36 items that best reproduced the physical and mental health summary scores for the SF-36 Health Survey. Summary scores then were estimated with 12 items in three ways: using standard (U.S.-derived) SF-12 items and scoring algorithms; standard items and country-specific scoring; and country-specific sets of 12 items and scoring. Replication of the 36-item summary measures by the 12-item summary measures was then evaluated through comparison of mean scores and the strength of product-moment correlations. Product-moment correlations between SF-36 summary measures and SF-12 summary measures (standard and country-specific) were very high, ranging from 0.94-0.96 and 0.94-0.97 for the physical and mental summary measures, respectively. Mean 36-item summary measures and comparable 12-item summary measures were within 0.0 to 1.5 points (median = 0.5 points) in each country and were comparable across age groups. Because of the high degree of correspondence between summary physical and mental health measures estimated using the SF-12 and SF-36, it appears that the SF-12 will prove to be a practical alternative to the SF-36 in these countries, for purposes of large group comparisons in which the focus is on overall physical and mental health outcomes.
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While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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An abridged five-item version of the 15-item International Index of Erectile Function (IIEF) was developed (IIEF-5) to diagnose the presence and severity of erectile dysfunction (ED). The five items selected were based on ability to identify the presence or absence of ED and on adherence to the National Institute of Health's definition of ED. These items focused on erectile function and intercourse satisfaction. For 1152 men (1036 with ED, 116 controls) analyzed, a receiver operating characteristic curve indicated that the IIEF-5 is an excellent diagnostic test. Based on equal misclassification rates of ED and no ED, a cutoff score of 21 (range of scores, 5-25) discriminated best (sensitivity=0.98, specificity=0. 88). ED was classified into five severity levels, ranging from none (22-25) through severe (5-7). Substantial agreement existed between the predicted and 'true' ED classes (weighted kappa=0.82). These data suggest that the IIEF-5 possesses favorable properties for detecting the presence and severity of ED.
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A systematic review was conducted on the prevalence of erectile dysfunction (ED) in the general population. Studies were retrieved which reported prevalence rates of ED in the general population. Using a specially developed criteria list, the methodological quality of these studies was assessed and data on prevalence rates were extracted. We identified 23 studies from Europe (15), USA (5), Asia (2) and Australia (1). On our 12-item criteria list, the methodological quality ranged from 5 to 12. The prevalence of ED ranged from 2% in men younger than 40 y to 86% in men 80 y and older. Comparison between prevalence data is hampered by major methodological differences between studies, particularly in the use of various questionnaires and different definitions of ED. We stress the importance of providing all necessary information when reporting on the prevalence of ED. Moreover, international studies should be conducted to establish the true prevalence of ED across countries.
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Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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This study examines the prevalence of DSM-III sexual dysfunctions and their association with comorbid drug and alcohol use in a community epidemiologic sample. The data for these analyses are based on the Epidemiological Catchment Area Project, a multistage probability study of the incidence and prevalence of psychiatric disorders in the general population conducted in 1981-83. Only the sample of 3,004 adult community residents in the St. Louis area was queried on DSM-III sexual dysfunctions of inhibited orgasm, functional dyspareunia (painful sex), inhibited sexual excitement (i.e., lack of erection/arousal), and inhibited sexual desire. There was a prevalence rate of 11% for inhibited orgasm, 13% for painful sex, 5% for inhibited sexual excitement, 7% for inhibited sexual desire, and 26% for any of these sexual dysfunctions (14% for men and 33% for women). The prevalence of qualifying lifetime substance use among the population was 37%, with males meeting more drug and alcohol use criteria than females. After controlling for demographics, health status variables, and psychiatric comorbidity (depression disorder, generalized anxiety disorder, antisocial personality disorder, and residual disorders), inhibited orgasm was associated with marijuana and alcohol use. Painful sex was associated with illicit drug use and marijuana use. Inhibited sexual excitement was more likely among illicit drug users. Inhibited sexual desire was not associated with drug or alcohol use.
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Risky sexual behaviors among adolescent males put them at risk for sexually transmitted diseases, HIV/AIDS, and unplanned fatherhood, yet few facilities in the United States provide focused sexual and reproductive health services to these young men. A general acknowledgement exists that the development of such services is needed, yet there is little research to guide providers in making existing services more attractive to young males and in developing new sexual health services for this population. This research aimed to explore attitudes and perceptions of urban black male adolescents regarding the availability of and access to reproductive healthcare. Eighteen black male adolescents participated in three focus group discussions held in a central New Jersey city. Transcripts of the discussions were analyzed using the constant comparative method. Resulting categories were grouped into themes, which reflected the adolescents' perceptions and experiences. Member checks were used to verify findings. Results: The adolescents felt that obtaining sexual health services was a stressful experience fraught with both internal and external barriers. Internal barriers included a fear of stigma and a loss of social status, shame, and embarrassment. External barriers included disrespectful providers, a lack of privacy/confidentiality, and challenges in accessing and negotiating the healthcare system. The young males described an idealized clinic environment as informal, welcoming, and respectful. Discussion and Providers should focus on improving the quality of care in existing clinics, particularly in the areas of access, privacy, and confidentiality, and on developing adolescent-friendly clinics focusing on male services. Adolescents should be encouraged to visit clinics prior to an acute need for services. There also is a need for providers who are comfortable with and able to communicate with male adolescents.
Article
Adolescence is associated with the onset of depressive symptoms as well as significant increases in health-risk behaviors. Potential explanations for the direction of effects in the association between depressive symptoms and health-risk behaviors include the self-medication/acting out hypothesis (i.e., early depressive symptoms predict increases in risk behaviors over time) and the failure hypothesis (i.e., early participation in health-risk behaviors predicts increases in depressive symptoms over time). The purpose of the present longitudinal study was to assess these competing hypotheses across the high school years, and to examine whether the direction of effects (and therefore the self-medication/acting out and failure hypotheses) may differ depending on the type of risk behavior under consideration. The sample consisted of 4,412 adolescents (49% female) who were followed up from grade nine to 12. Adolescents reported on their depressive symptoms and six health-risk behaviors (frequency of alcohol use, amount of alcohol consumed per drinking episode, cigarette smoking, marijuana use, hard drug use, and delinquency). Analyses were conducted with dual trajectory growth curve modeling. Adolescents who had higher depressive symptoms in grade nine reported faster increases than their peers in smoking, marijuana, and hard drug use across the high school years, supporting the self-medication hypothesis. The failure hypothesis was not supported. The results are important because they suggest that by targeting depressive symptoms during early adolescence, treatment programs may prevent increases in the frequency of these risk behaviors later in adolescence.
Article
We aimed to determine the prevalence of early ejaculation disorders (EED) and to calculate the prevalence of lifelong premature ejaculation (PE) in Greek urban men. Associations with physiological and psychological conditions, treatment-seeking and treatment efficacy were defined. We surveyed 522 urban men aged 16-62 individually using an open, one-on-one questionnaire. A total of 305 (58.43%) participants reported EED. The prevalence of lifelong PE, according to the International Society for Sexual Medicine criteria, was calculated as 17.7%. Among sufferers of EED, unrelated stress was the most frequent comorbidity (42.6%) and, along with erectile dysfunction and lower urinary tract symptoms, occurred more frequently than in normal participants (P < 0.05). Half (50.3%) of the sufferers believed that their problem was psychological, while 69.5% never sought help. Most (69.2%) of those who did seek help sought it anonymously through the internet. Behavioural treatment was preferred to medical treatment. Few (13.8%) men were satisfied with their treatment. In conclusion, although the observed PE prevalence agrees with the previous findings, more patients suffer negative personal and relationship consequences and may also require treatment. Most men do not seek medical assistance, and from those who do, most are not satisfied with the results of treatment.
Article
Studies have linked obesity, a sedentary lifestyle, and tobacco smoking to erectile dysfunction, but the evidence linking unhealthy lifestyle factors to other sexual dysfunctions or to sexual inactivity is conflicting. To examine associations between unhealthy lifestyle factors and sexual inactivity with a partner and four specific sexual dysfunctions in each sex. We used nationally representative survey data from 5,552 Danish men and women aged 16-97 years in 2005. Cross-sectional associations of lifestyle factors with sexual inactivity and sexual dysfunctions were estimated by logistic regression-derived, confounder-adjusted odds ratios (ORs). We calculated ORs for sexual inactivity with a partner and for sexual dysfunction and sexual difficulties overall in both sexes, for erectile dysfunction, anorgasmia, premature ejaculation, and dyspareunia in men, and for lubrication insufficiency, anorgasmia, dyspareunia, and vaginismus in women. Obesity (body mass index [BMI]≥30 kg/m(2) ) or a substantially increased waist circumference (men ≥102 cm; women ≥88 cm), physical inactivity, and, among women, tobacco smoking were each significantly associated with sexual inactivity in the last year. Among sexually active men, both underweight (BMI <20 kg/m(2) ) and obesity, a substantially increased waist circumference, physical inactivity in leisure time, high alcohol consumption (>21 alcoholic beverages/week), tobacco smoking, and use of hard drugs were each significantly positively associated with one or more sexual dysfunctions (ORs between 1.71 and 22.0). Among sexually active women, the only significant positive association between an unhealthy lifestyle factor and sexual dysfunction was between hashish use and anorgasmia (OR 2.85). In both sexes, several unhealthy lifestyle factors were associated with sexual inactivity with a partner in the last year. Additionally, among sexually active participants, men with unhealthy lifestyles were significantly more likely to experience sexual dysfunctions. Considering the importance of a good sex life, our findings may be useful in attempts to promote healthier lifestyles.
Article
Premature ejaculation (PE) is common. However, it has been underreported and undertreated. To determine the prevalence of PE and to investigate possible associated factors of PE. This cross-sectional study was conducted at a primary care clinic over a 3-month period in 2008. Men aged 18-70 years attending the clinic were recruited, and they completed self-administered questionnaires that included the Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function, sociodemography, lifestyle, and medical illness. The operational definition of PE included PE and probable PE based on the PEDT. Prevalence of PE. A total of 207 men were recruited with a response rate of 93.2%. There were 97 (46.9%) Malay, 57 (27.5%) Chinese, and 53 (25.6%) Indian, and their mean age was 46.0 ± 12.7 years. The prevalence of PE was 40.6% (N = 82) (PE: 20.3%, probable PE: 20.3% using PEDT). A significant association was found between ethnicity and PE (Indian 49.1%, Malay 45.4%, and Chinese 24.6%; χ(2) = 8.564, d.f. = 2, P = 0.014). No significant association was found between age and PE. Multivariate analysis showed that erectile dysfunction (adjusted odds ratio [OR] 4.907, 95% confidence interval [CI] 2.271, 10.604), circumcision (adjusted OR 4.881, 95% CI 2.346, 10.153), sexual intercourse ≤5 times in 4 weeks (adjusted OR 3.733, 95% CI 1.847, 7.544), and Indian ethnicity (adjusted OR 3.323, 95% CI 1.489, 7.417) were predictors of PE. PE might be frequent in men attending primary care clinics. We found that erectile dysfunction, circumcision, Indian ethnicity, and frequency of sexual intercourse of ≤5 times per month were associated with PE. These associations need further confirmation.
Article
The psychological impacts of premature ejaculation (PE), which include guilt, anxiety, and distress, have been well established in Western countries. However, in Asia, although a substantial number of epidemiological studies have surveyed the prevalence of PE, researchers have not thoroughly investigated the relationship between PE and depression, or have defined PE properly. We studied the association between PE and depression and other psychological disturbances, in a Korean cohort by applying an appropriate definition for PE and validated outcome measures of depression. METHODS.  A total of 956 males (≥20 years) were initially approached via an Internet survey company. Participants were asked to complete a questionnaire requesting detailed medical and sexual histories, which included questions from the Erectile Function Domain score in the International Index of Erectile Function (IIEF-EF) and the Beck Depression Inventory (BDI). The prevalence of PE was evaluated using two different definitions-self-assessed PE and presumed PE. Presumed PE was defined as a short ejaculation time (an estimated intravaginal ejaculatory latency time ≤5 minutes), an inability to control ejaculation, and the presence of distress resulting from PE. Ejaculation-related questionnaire, the IIEF-EF, and BDI. A total of 334 men were evaluated. The prevalence of PE was 10.5% according to the Presumed PE definition, whereas by self-assessment, it was 25.4%. Self-assessed PE patients suffered from various psychological problems, such as depression, low self-esteem, bother, and low sexual satisfaction. Even after excluding erectile dysfunction (ED) subjects, a significant relationship was found between self-assessed PE and depression. Moreover, after further classification of the Self-assessed PE group, we found that subjects included in this group, but not in the Presumed PE group, suffered more from psychological burden than any other members of the cohort. Korean men with subjective perceptions of PE are prone to various psychological problems, which include depression.
Article
Past literature has provided conflicting evidence for the association between adolescent sexual intercourse and depressive symptomatology. Whereas some studies conclude that sexually active youth may be at risk for depression, others provide contrary results. Thus, it is unclear as to whether depression results directly from coitus or if this relationship is explained by other factors-that is, there may be biological, psychological, or sociological predictors of both depressive symptomatology and early sexual intercourse. Using the National Longitudinal Study of Adolescent Health dataset, depressive symptomatology in adolescents over a seven-year time period was analyzed. The final sample (n = 6,510) was comprised of 49.35% male (n = 3,213) and 50.65% female (n = 3,297) participants. Although an earlier age of first coitus was predictive of future depressive symptoms, both variables appear to be concomitant outcomes of the biopsychosocial process. Thus, although one may be able to use early coitus as a marker for subsequent depressive symptomatology, it does not appear to occur because of early sexual intercourse. Furthermore, the reverse relationship was not found to be significant in this study-that is, higher levels of previous depressive symptomatology did not predict an earlier age of first sexual intercourse in adolescents.
Article
Premature ejaculation (PE) is suspected to be the most prevalent male sexual complaint, and the prevalence of PE is considerably high also in the younger generation. We investigated the PE prevalence based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed text revision; DSM-IV-TR) definition and the risk factors of PE in Korean young men via Internet survey. Subjects (n = 3980) aged from 20 to 59, who performed sexual intercourse more than once a month during the past 6 months were asked to participate in this study. Participants were asked to complete a questionnaire that consisted of questions on general, medical, and sexual history related to ejaculation. A total of 600 subjects were included in this study. PE prevalence was found to be 18.3%. Prevalences were not significantly different across age groups, after excluding subjects with erectile dysfunction (ED). Educational level, marital status and duration, average income, sexual orientation, smoking, alcohol consumption, and circumcision status showed no difference in the PE and non-PE groups. Partners perceived satisfaction rates were 45.0% in the PE group and 63.9% in the non-PE group. Significant differences were found between the PE and non-PE groups in terms of ED, obesity, and depression prevalence. However, multiple logistic regression analysis revealed that the significant risk factors of PE were age and the frequency of conversations with partners about sexual intercourse. This Internet-based study is limited because participants probably represent a selected population of Internet users with non-representative educational and socioeconomic profiles. This study is the first to report the prevalence of both self-reported PE and PE on the basis of the DSM-IV-TR definition in the Korean population. This study demonstrates that PE in Korea is as prevalent as it is in European countries and the United States.
Article
Sexual dysfunction is a common symptom of depression. Although decreased libido is most often reported, difficulties with arousal, resulting in vaginal dryness in women and erectile dysfunction in men, and absent or delayed orgasm are also prevalent. Sexual dysfunction is also a frequent adverse effect of treatment with most antidepressants and is one of the predominant reasons for premature drug discontinuation. Selective serotonin reuptake inhibitors are the most widely prescribed antidepressants and have significant effects on arousal and orgasm compared with antidepressants that target norepinephrine, dopamine, and melatonin systems. The availability of an antidepressant that does not cause or exacerbate sexual dysfunction represents an advance in pharmacotherapy for mood disorders and should reduce treatment noncompliance and decrease the need for switching antidepressants or adding antidotes. The purpose of this review was to provide an update on the prevalence, psychobiology, and relative adverse effect burden of sexual dysfunction associated with different antidepressants.
Article
Erectile dysfunction (ED) is common among men with an elevated body mass index (BMI). However, a high waist circumference (WC) and low levels of physical activity may predict ED independently of BMI. We investigated the independent relationships between BMI, WC, and physical activity with ED. Subjects consisted of 3,941 adult men (age > or = 20 years) with no history of prostate cancer from the 2001-2004 National Health and Nutrition Examination Survey. Logistic regression analyses were used to examine the relative odds of ED association with categories of BMI, WC, and physical activity. Established thresholds were used to divide subjects into three WC and BMI categories. Physical activity level was divided into active (> or =150 min/week), moderately active (30-149 min/week), and inactive (<30 min/week) categories. A single survey question was used to assess the presence of ED. After control for potential confounders, men with either a high WC or an obese BMI had an approximately 50% higher odds of having ED compared with men with a low WC or a normal BMI, respectively. Further, moderately active or inactive men had an approximately 40-60% greater odds of ED compared with active men. When all three predictors (WC, BMI, and physical activity level) were entered into the same logistic regression model, both a high WC and low physical activity level (moderately active and inactive) were independently associated with a greater odds of ED, whereas BMI level was not. Maintaining a WC level below 102 cm and achieving the recommended amount of moderate-intensity physical activity (>or =150 min/week) is associated with the maintenance of proper erectile function, regardless of BMI level. These findings suggest that the clinical screening for ED risk should include the assessment of WC and physical activity level in addition to BMI.
Article
Limited data are available supporting the notion that treatment of lifestyle risk factors may improve erectile dysfunction (ED). In the present study, we analyzed the effect of a program of changing in lifestyle designed to improve erectile function in subjects with ED or at increasing risk for ED. Men were identified in our database of subjects participating in randomized controlled trials evaluating the effect of lifestyle changes. A total of 209 subjects were randomly assigned to one of the two treatment groups. The 104 men randomly assigned to the intervention program received detailed advice about how to reduce body weight, improve quality of diet, and increase physical activity. The 105 subjects in the control group were given general information about healthy food choices and general guidance on increasing their level of physical activity. Changes in erectile function score (International Index of Erectile Function-5 [IIEF-5]; items 5, 15, 4, 2, and 7 from the full-scale IIEF-15) and dependence of the restoration of erectile function on the changes in lifestyle that were achieved. Erectile function score improved in the intervention group. At baseline, 35 subjects in the intervention group and 38 subjects in the control group had normal erectile function (34% and 36%, respectively). After 2 years, these figures were 58 subjects in the intervention group and 40 subjects in the control group, respectively (56% and 38%, P = 0.015). There was a strong correlation between the success score and restoration of erectile function. It is possible to achieve an improvement of erectile function in men at risk by means of nonpharmacological intervention aiming at weight loss and increasing physical activity.
Article
Despite increasing demand for clinical interventions into sexual problems in an aging population, epidemiological data on the subject are scarce. To examine the prevalence of sexual problems across different sociodemographic groups, and risk factors for these problems in multiple domains of life. Statistical analysis of data from the 2005-2006 National Social Life, Health, and Aging Project (NSHAP), a nationally representative U.S. probability sample of 1,550 women and 1,455 men aged 57-85 at the time of interview. Likelihood of experiencing sexual dysfunction in the preceding 12 months. Sexual problems among the elderly are not an inevitable consequence of aging, but instead are responses to the presence of stressors in multiple life domains. This impact may partly be gender differentiated, with older women's sexual health more sensitive to their physical health than is true for men. The mechanism linking life stress with sexual problems is likely to be poor mental health and relationship dissatisfaction. The NSHAP results demonstrate the consistent impact of poor mental health on women's reports of sexual problems and the less consistent association with men's problems. The results point to a need for physicians who are treating older adults experiencing sexual problems to take into account not simply their physical health, but also their psychosocial health and satisfaction with their intimate relationship.
Article
This article compares five indices of alcohol consumption in a general population survey conducted in 1985 in the Netherlands. Self-reports of consumption were obtained with a prospective diary, a retrospective 7-day recall method, and three summary measures, such as a quantity-frequency index. The coverage of sales data appeared highest for the diary (67%), which suggests a higher validity. Special attention was given to comparisons of quantity and frequency of drinking between the diary, on the one hand, and the weekly recall and summary measures, on the other. It was found that underreporting, relative to the diary reports, was generally higher in the frequency than in the quantity domain. This result, together with the finding from longitudinal studies that intraindividual variation is also higher for drinking frequency, leads to the conclusion that forgetting is a potent source of undercoverage in surveys and to the hypothesis that large differences in overall drinking pattern between populations (e.g., in regularity of drinking) may account for the large differences in coverage rates of sales data. Furthermore, the subjectively assessed probability of drinking by means of a "usual" frequency question appeared a poor predictor of (diary) drinking frequency for respondents reporting a low or moderate frequency. For subjects claiming a high "usual" drinking frequency, a reasonable correspondence between diary and summary measures was found. This mitigates the fear often expressed that heavy drinkers particularly underreport their consumption.
Article
This study assessed 62 men for their expectations of primary care physicians in attending to sexual health concerns. The physician was the professional most preferred for consultation regarding sexual concerns, and men look for qualities of professionalism, empathy, trust, and comfort in their physician. While 97% of the men reported prior sexual concerns, only 19% had discussed these issues with their doctor. Most were hesitant, but wanted to deal with sex problems. They preferred that the physician initiate the discussion. These findings suggest an under-utilization of sexual health care by men and support the role of the primary care physician as an important sexual health provider.
Article
The literature on the sexual side effects of drugs and chemicals has been reviewed. There are many substances which alter the human sociosexual response cycle either negatively, positively or both. Many of the drugs used therapeutically have been reported to have adverse effects on sexuality, and this must be taken into account when these drugs are used clinically. Many substances which are used for recreational purposes (or sometimes abused) also have profound effects on sexual response. Many of these substances are used in such a way that they can correct underlying sexual problems. Treatment of a drug abuser may well prove unsuccessful without consideration of preexistent sociosexual problems and concerns. From the dawn of recorded history, many substances have been used for the purpose of sexual enhancement. Some of these have known success and their reputations have been passed down through the millenia. The chapter has not yet been closed on aphrodisiacs, even though none have survived the rigors of scientific scrutiny. As long as humans place value on optimal sexual functioning, there will be a demand for sex-enhancing drugs. In order for the scientific and medical community to successfully meet these challenges, more effective and relevant study designs will have to be utilized in order to separate fact from fancy. The study of pharmacosexology is in its infancy, and in order for it to grow and contribute to the world body of knowledge, more researchers and clinicians must be trained in both pharmacology and sexology.
Article
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Article
Erectile dysfunction (ED) affects millions of men throughout the world. The literature is ample, but an accurate estimate of its prevalence is still difficult since figures mainly refer to the USA, and are based mostly on small selected samples of people. Caution must anyway be used in comparing data from studies conducted in the past because of possible differences in the definition and classification of ED. Many factors are believed to contribute to the development and maintenance of ED. The influence of age and of several medical conditions (diabetes, vascular disease, and chronic diseases such as hepatic failure, renal failure and dialysis) is well defined. Also well documented is the role of some drug groups, whereas the role of other pharmacological agents is still controversial because of the frequent coexistence of other pathological conditions or concomitant exposure to other drugs. Less well defined and sometimes controversial is the role of risk factors mainly related to life-style such as cigarette smoking, alcoholism, total cholesterol levels and certain types of trauma. This paper reviews the main data on the epidemiology of ED and some related risk factors.
Article
In the ongoing Zurich Cohort Study, 591 males and females from the general population of Zurich were interviewed five times over the 15-year period between the ages of 20 and 35 years. The data on sexual problems were mainly obtained from the final three interviews when the subjects were aged 28-35 years. Emotional problems or sexual dysfunction alone are rare and are almost always associated with each other, or with changes in libido. However, changes in libido without associated emotional problems or sexual dysfunction are relatively common. Libido therefore appears to be the core problem with which other sexual problems overlap. Overall, sexual problems of some type were found in 26% of normal subjects, 45% of non-treated depressed patients and 63% of treated depressed patients. This increase in sexual problems in treated depressed patients is mainly due to an increase in sexual dysfunction and emotional problems; the level of libido appears not to be affected by treatment. There was no difference in the prevalence of sexual problems of any kind between patients treated with medication and those treated only with psychotherapy.
Article
A self-rating inventory has been developed to measure DSM-IV and ICD-10 diagnoses of major (moderate to severe) depression by the patients' self-reported symptoms. This Major Depression Inventory (MDI) can be scored both according to the DSM-IV and the ICD-10 algorithms for depressive symptomatology and according to severity scales by the simple total sum of the items. The Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used as index of validity for the clinician's DSM-IV and ICD-10 diagnosis of major (moderate to severe) depression. The sensitivity and specificity of MDI was assessed in a sample of 43 subjects covering a spectrum of depressive symptoms. The sensitivity of the MDI algorithms for major depression varied between 0.86 and 0.92. The specificity varied between 0.82 and 0.86. When using the total score of MDI the optimal cut-off score was estimated 26 and the total score was shown to be a sufficient statistic. The sample of subjects was limited. Patients with psychotic depression were not included. The MDI was found to have a sensitivity and specificity which is acceptable. The questionnaire is brief and can be scored diagnostically by the DSM-IV and ICD-10 algorithms as well as by its simple total score.
Article
Little is known about men's expectations of their family physicians regarding sexual disorders. Our goal was to evaluate the frequency of sexual problems among male patients in family practice and to assess their need for help. We performed a cross-sectional survey based on structured questionnaires answered by patients and physicians in German family practices. We approached 43 family physicians; 20 (43%) participated. On a single day all men 18 years and older visiting the participating practices were approached, and 307 (84%) took part in the survey. Patients were asked about their frequency and type of sexual problems, their need for help, and their expectations of their physicians. The physicians described their perceptions and management of sexual problems in family practice. Nearly all patients (93%) reported at least 1 sexual problem from which they suffered seldom or more often. The most common problems were low sexual desire (73%) and premature ejaculation (66%). Occupational stress was considered causative by more than half of the men (107/201). Forty-eight percent considered it important to talk with their physicians about sexual concerns. However, most physicians initiated a discussion about sexual concerns only seldom or occasionally. There was a nonsignificant correlation between the physicians' assumed knowledge and the patients' wish to contact them in case of sexual problems (rho=0.26). The high frequency of self-reported sexual disorders and the hesitancy of family physicians to deal with this topic signals a neglected area in primary health care. Certain conditions, such as occupational stress, which may be associated with sexual concerns, should encourage the physician to initiate discussions about sexuality.
Article
Although many studies have provided data on erectile dysfunction in specific settings, few studies have been large enough to precisely examine age-specific prevalence and correlates. To describe the association between age and several aspects of sexual functioning in men older than 50 years of age. Cross-sectional analysis of data from a prospective cohort study. U.S. health professionals. 31 742 men, age 53 to 90 years. Questionnaires mailed in 2000 asked about sexual function, physical activity, body weight, smoking, marital status, medical conditions, and medications. Previous biennial questionnaires since 1986 asked about date of birth, alcohol intake, and other health information. When men with prostate cancer were excluded, the age-standardized prevalence of erectile dysfunction in the previous 3 months was 33%. Many aspects of sexual function (including overall function, desire, orgasm, and overall ability) decreased sharply by decade after 50 years of age. Physical activity was associated with lower risk for erectile dysfunction (multivariable relative risk, 0.7 [95% CI, 0.6 to 0.7] for >32.6 metabolic equivalent hours of exercise per week vs. 0 to 2.7 metabolic equivalent hours of exercise per week), and obesity was associated with higher risk (relative risk, 1.3 [CI, 1.2 to 1.4] for body mass index >28.7 kg/m2 vs. <23.2 kg/m2). Smoking, alcohol consumption, and television viewing time were also associated with increased prevalence of erectile dysfunction. Men who had no chronic medical conditions and engaged in healthy behaviors had the lowest prevalence. Several modifiable health behaviors were associated with maintenance of good erectile function, even after comorbid conditions were considered. Lifestyle factors most strongly associated with erectile dysfunction were physical activity and leanness.
Article
The objective of this study was to estimate the prevalence of erectile dysfunction (ED) and its health-related correlates among Danish men, to evaluate the influence of age, tobacco smoking, educational level and medication and the needs for treatment and willingness to be treated. A validated questionnaire was sent to 4310 noninstitutionalized Danish men, aged 40-80 y. The men selected constituted all male patients aged 40-80 y in 12 general practitioner practices in a county of Zealand, representing both the urban and rural population. Besides age, education, marital status and International Index of Erectile Function, the questionnaire included the duration of sexual problems (ED, premature ejaculation, penile curvature), comorbidity, medication, risk factors and the effect of prior treatment and willingness to seek treatment for sexual problems. A total of 2210 men responded, giving a response rate of 51.3%. No difference in the response rate by age groups was noted. The prevalence of complete ED increased with increasing age: 40-45 y, ED: 4.5%; 50-55 y, ED: 11.1%; and 75-80 y ED: 52%. The frequency of ED increased three-fold from men without comedication to men having some kind of medical treatment. Risk factors included tobacco smoking and low educational level. Only 9% suffering from ED had received some kind of treatment. Of the treated men, 75% were satisfied with the treatment. Willingness to discuss sexual matters depended both upon the age of the man and his actual erectile function. Taboos were seen more frequently among elderly people. ED increases with age, but only 10% of the men with sexual problems seek advice. Medication predisposes to ED.