No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Impotence in Medical Clinic Outpatients
Abstract
One thousand one hundred eighty men in a medical outpatient clinic were screened as to the presence of impotence. Four hundred one men (34%) were impotent, and of those, 188 (47%) chose to be examined for their problem. After a comprehensive evaluation the following diagnoses were obtained: medication effect, 25%; psychogenic, 14%; neurological, 7%; urologic, 6%; primary hypogonadism, 10%; secondary hypogonadism, 9%; diabetes mellitus, 9%; hypothyroidism, 5%; hyperthyroidism, 1%; hyperprolactinemia, 4%; miscellaneous, 4%; and unknown causes, 7%. The mean age of the impotent patients was 59.4 years, and the prevalence of alcoholism was 7%. Luteinizing hormone, follicle-stimulating hormone, testosterone, thyroxine, triiodothyronine (T3), T3 resin uptake, and prolactin studies were necessary to diagnose individual cases. We conclude that erectile dysfunction is a common and often overlooked problem in middle-aged men followed in a medical clinic.
(JAMA 1983;249:1736-1740)
Background
The association between disease activity and erectile dysfunction (ED) in patients with inflammatory bowel disease (IBD) is inconsistent, although IBD, including ulcerative colitis (UC), is reported as a risk factor for ED.
Aim
The purpose of this study was to explore this association in Japanese patients with UC.
Methods
In this study, we enrolled 165 Japanese male patients with UC. Information regarding the Sexual Health Inventory for Men (SHIM) score, medication, and severity of UC was obtained from medical records, self-administered questionnaires, and reports from physicians. The definition of ED and severe ED is a SHIM score <17 and <8, respectively.
Outcomes
No association between severity of UC and ED was found in Japanese patients. Aging is independently positively associated with ED in patients with UC.
Results
The prevalence of severe ED and ED was 47.9% and 64.9%, respectively. In this study, mucosal healing, clinical remission, duration of UC, disease extent, and medication were not associated with the prevalence of ED. Older age (≥63 years of age) was independently positively associated with ED (adjusted odds ratio, 12.93; 95% CI: 4.51-43.00) and severe ED (adjusted odds ratio, 9.02; 95% CI: 3.66-23.91).
Clinical Implications
Disease severity of UC might not be associated with the prevalence of ED in patients with UC.
Strengths and Limitations
This is the first study to investigate the association between several factors regarding UC activity and ED. The limitation of this study is the definition of ED based on SHIM scores.
Conclusion
No association between severity of UC and ED was found in Japanese patients. As expected, aging may be independently positively associated with ED in patients with UC.
This pooled safety analysis assessed the incidence of hypotension‐related treatment‐emergent adverse events (TEAEs) and major adverse cardiovascular events (MACEs) in patients with concomitant use of tadalafil and antihypertensive medications. Data were pooled from seventy‐two Phase II–IV studies conducted on patients with a diagnosis of erectile dysfunction (ED) and/or benign prostate hyperplasia (BPH). Studies were categorized as either All placebo‐controlled studies or All studies. The incidences of hypotension‐related TEAEs and MACEs were analyzed by indication; by use of concomitant antihypertensive medications; and by the number of concomitant antihypertensive medications. A total of 15 030 and 22 825 patients were included in the analyses for All placebo‐controlled studies and All studies, respectively. In the All placebo‐controlled studies, the incidence of hypotension‐related TEAEs and MACEs was ranging between 0.6–1.5% and 0.0–1.0%, respectively, across all indications. Tadalafil was associated with an increase in hypotension‐related TEAEs only in the ED as‐needed group not receiving any concomitant antihypertensive medications (p‐value = .0070); no significant difference was reported between placebo and tadalafil in the groups of patients receiving ≥1 antihypertensive medication (p‐values ≥ .7386). Similarly, no significant differences (p‐values≥ .2238) were observed in the incidence of MACEs between tadalafil and placebo treatment groups, with or without concomitant use of antihypertensive medications, and across all indication categories. In the All studies group, results were similar. The pooled analysis showed no evidence that taking tadalafil alongside antihypertensive medications increases the risk of hypotension‐related TEAEs or MACEs compared with antihypertensive medications alone.
Modifiable lifestyle-related risk factors are the object of increasing attention, with a view to primary and tertiary prevention, to limit the onset and development of diseases.
Also in the urological field there is accumulating evidence of the relationship between urological diseases and lifestyle-related risk factors that can influence their incidence and prognosis. Risk factors such as nutrition, physical activity, sexual habits, tobacco smoking, or alcohol consumption can be modified to limit morbidity and reduce the social impact and the burdensome costs associated with diagnosis and treatment.
This review synthesizes the current clinical evidence available on this topic, trying to satisfy the need for a summary on the relationships between the most important lifestyle factors and the main benign urological diseases, focusing on benign prostatic hyperplasia (BPH), infections urinary tract (UTI), urinary incontinence (UI), stones, erectile dysfunction, and male infertility.
Objective
To review the current literature on the nature and prevalence of sexual difficulties in the population with chronic musculoskeletal pain, as well as to identify the biopsychosocial factors that maintain these difficulties.
Design
Systematic review.
Methods
Studies were found by using multiple electronic databases and examining reference lists. After application of inclusion and exclusion criteria, 10 studies were eligible for review. Data were extracted and characteristics were described for outcomes of interest (i.e., sexual dysfunction, pain condition, pain intensity, psychosocial factors, gender differences). Cochrane Risk of Bias was assessed for all included studies.
Results
Ten studies (2,941 participants) were included in the review. Musculoskeletal conditions included low back pain and fibromyalgia. All studies examining sexual functioning found evidence of sexual difficulty among patients with chronic pain. Three studies demonstrated that sexual dysfunction was significantly greater in patients than in healthy matched controls. Nine studies found that greater pain levels significantly correlated with greater sexual dysfunction. Eight studies noted an increased prevalence of sexual difficulties in those with comorbid psychological problems. Heterogeneity between studies was identified, particularly with regard to gender outcomes. The risk-of-bias assessment also highlighted limitations in approximately half of studies.
Conclusions
This review reiterates the importance of investigating sexual functioning in the chronic musculoskeletal pain population, given the high prevalence of chronic musculoskeletal pain across all age bands. Given methodological limitations, future research should develop measures that sensitively cater to the various needs of patients with chronic pain. By modifying assessment to include biopsychosocial concerns, practitioners can tailor treatment to address transdiagnostic factors that maintain sexual dysfunction.
Background:
Prescription medications are among the most common causes of sexual dysfunction, and patients are often hesitant to seek help when experiencing these symptoms.
Objective:
In this review, we identify the available evidence of sexual adverse effects in men using systemic dermatologic medications and suggest screening protocols and actions that may improve a patient's symptoms where possible.
Methods:
A systematic review was conducted of all articles in the PubMed database published from the time of inception to May 2018 to identify studies evaluating the use of systemic dermatologic medications in men with evidence of sexual adverse effects. Subsequently, a secondary in-depth literature review was performed for each individual medication.
Results:
There were 5497 articles reviewed in the primary systematic review, and 59 articles covering 11 systemic dermatologic medications met inclusion criteria. We identified level 1 evidence for sexual adverse effects as a primary outcome in patients taking finasteride.
Limitations:
Many included studies were limited by sample size and methodology.
Conclusion:
The information in this review may serve as a reference of adverse effects when deciding on a therapeutic agent and a guide to help identify patients to screen for sexual dysfunction.
Background:
Individually, thyroid disease and sexual dysfunction are common conditions that can have a detrimental effect on quality of life. Recent reports have documented an increased prevalence of sexual dysfunction among patients with thyroid disorders. As such, it is important for sexual medicine physicians to be primed on the presentation of patients with overlying sexual and thyroid dysfunction to allow for proper management.
Aim:
To review the available literature exploring the relationship between thyroid disease and sexual dysfunction in men and women.
Methods:
A PubMed review of existing clinical and pre-clinical studies from 1978 through 2018 was performed.
Main outcome measures:
The prevalence, symptomatology, pathophysiology, diagnosis and management of patients with sexual dysfunction in the setting of thyroid disease were reviewed.
Results:
The prevalence of sexual dysfunction in patients with hypothyroid (59-63% and 22-46% in men and women, respectively) and hyperthyroidism (48-77% and 44-60% in men and women, respectively) has been estimated in select populations. Both hypothyroidism and hyperthyroidism were strongly associated with erectile and ejaculatory dysfunction: hypothyroidism with delayed ejaculation, hyperthyroidism with pre-mature ejaculation. Hypothyroidism and hyperthyroidism have been reported to impair libido in men and women; however, evidence of hypothyroidism's impact on male libido is mixed. Hypothyroid and hyperthyroid women demonstrated impairments in desire, arousal/lubrication, orgasm, satisfaction, and pain during intercourse. Mechanistically, hypothyroidism and hyperthyroidism exert effects on circulating sex hormone levels through peripheral and central pathways and can indirectly provoke psychiatric and autonomic dysregulation that can impair sexual function. Correction to euthyroid state was associated with dramatic resolution of sexual dysfunction in both male and female patients with hypothyroidism or hyperthyroidism.
Conclusion:
By improving awareness of the link between thyroid disease and sexual dysfunction, sexual medicine physicians may sooner identify patients whose sexual symptoms may be remedied by treating an underlying thyroid disorder. Gabrielson AT, Sartor RA, Hellstrom WJG. The Impact of Thyroid Disease on Sexual Dysfunction in Men and Women. Sex Med Rev 2018;XX:XXX-XXX.
Infertility and sexual dysfunction in men, specifically erectile dysfunction (ED), are distinct entities that share a complex and interdependent relationship with one another. This chapter discusses the similarities and differences between the etiologies and treatments for each condition, and highlights the potential impact infertility may have on male sexual function. It provides a discussion of the similarities and differences between ED and male infertility in terms of etiology and treatment as well as the potential impact a diagnosis of infertility may have on male erectile function. Numerous causes of ED and male infertility have been identified to date, though it is clear that not all etiologies are known for either condition. Ultimately, the clear association between ED and male infertility highlights the need to consider these entities together when evaluating the infertile male or the male with erectile difficulties, and to target the evaluation and treatment approaches to afflicted men.
Backgound: The number of hypogonads is increasing day by day. It may be due to sedentary life style with increased obesity, increased tension or stressed lifestyle among all groups of populations. Visceral obesity is associated with insulin resistance, diabetes mellitus and also with hypogonadism. Objective: This study was carried out to determine the proportion of insulin resistance among male subjects with hypogonadism in different age groups along with status of erectile quality among diabetics and non diabetics. Materials and method: This cross sectional study among 161 adult male subjects aged ? 20 to ? 60 years were purposively selected from Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh between May 2009 to September 2010. Glycemic status and insulin resistance (by HOMA-R) were done and relevant history were documented. Results: The highest proportion (38.9%) of hypogonadism was in ? 50 years age group whereas highest proportion (39.6%) of the eugonads was in the age group of 40 to 49 years. More than half of the hypogonad subjects had weak erectile quality (54.0%) which were followed by absent erectile quality in 32.7% and 13.3% subjects had normal erectile quality. Among the eugonad subjects 41.7% had normal erectile quality, 41.6% subjects had weak erectile quality and 16.7% subjects had no erectile quality. More than ninety percent of the hypogonad subjects and about 60% of the eugonad subjects had insulin resistance. The average HOMA-R was more in the subjects with hypogonadism with diabetes which was highly significant (p-value < 0.001). Conclusion: Hypogonadism is associated with insulin resistance.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14968 Delta Med Col J. Jan 2013;1(1):3-7
Endocrine disorders (except diabetes mellitus) represent an infrequent cause of erectile dysfunction. However, identification of an endocrine disorder in these patients is essential for three major reasons. First, it provides an opportunity for etiologic management of erectile dysfunction instead of symptomatic. Second, endocrine disorders associated with erectile dysfunction might also have important adverse sequelae on the general health and should therefore be timely identified and managed. Third, a limited panel of hormonal tests (i.e., serum total testosterone, thyrotropin, and prolactin levels) is frequently sufficient for reaching a diagnosis of these endocrine disorders. In the present chapter, the endocrine disorders most frequently associated with erectile dysfunction are discussed, with emphasis on their prevalence in patients with erectile dysfunction, the diagnostic work-up, and the effects of their management on erectile function.
In both sexes, the normal process of ageing brings about certain changes in sexual capacity and the emotional and sensory experience of sexuality. This is to be expected, for many of the body’s functions change as we age. In our sixties we no longer expect to run as fast as we did in our twenties even if we are perfectly healthy, and in more subtle ways the body changes in its resistance to stress and disease. The general decline in our physical powers has led to a false belief that sexuality, both in terms of performance, needs and interest, should normally fade out somewhere in the late fifties, and that if it persists it may take pathological forms. Thus Havelock Ellis (1933) popularized the idea that there was something abnormal and potentially dangerous in older people remaining sexually active. He wrote:
There is a frequent well marked tendency in women at the menopause to an eruption of sexual desire, the last flaring up of a dying fire, which may easily take on a morbid form.
Similarly in men, when the approach of age begins to be felt, the sexual impulse may become suddenly urgent. In this instinctive reaction it may tend to roam, normally or abnormally, beyond legitimate bounds. ... This late exacerbation of sexuality becomes still more dangerous if it takes the form of an attraction to girls who are no more than children, and to acts of indecent familiarity with children. ... the average age of the victim regularly decreases as the average age of the perpetrator increases (Ellis, 1933, pp. 181–182).
Endocrine and metabolic disorders are among the most common problems seen by family physicians. For example, according to the National Ambulatory Medical Care Survey, visits to general and family physicians accounted for 53.4% of the estimated 11 million office-based visits for which diabetes was the principal or first-listed diagnosis.1
The concept that hormonal imbalances can account for sexual dysfunction has both rational and irrational bases. The association of absence of the testes with marked diminution of male copulatory behavior was made in antiquity. In this century, the isolation and actual synthesis of the active testicular factors that could restore phenotypic virilization in castrated men should have paved the way for more refined investigations of the effects of testicular steroids and their analogues on sexual behavior. Furthermore, the rather recently acquired ability to accurately measure blood and tissue levels of most of the hormones known to regulate reproduction should have allowed us to discover any and all causal links between documented sexual dysfunction and hormonal deficits and/or excesses. It is not widely acknowledged that these have been established, and I wish to devote space to understanding why wishful thinking still persists in both patients and practitioners before I outline what I consider to be the proper, modest hormonal evaluation of a man with a chief complaint of erectile dysfunction.
Erectile problems are quite common. As reviewed in previous chapters, approximately 10% of healthy young males have been reported to complain of erectile dysfunction.1 In patients with chronic diseases, the prevalence of impotence probably exceeds 30%.2–4 It is clear that these problems are a source of considerable personal distress to many of these men and that because of personal embarrassment many patients do not volunteer such information to their physicians. It appears that physicians as a group have been remiss in not directly inquiring about sexual function in our patients. This omission on our part is unfortunate as many of these men might be helped by recent advances in diagnosis and treatment and thus avoid considerable personal suffering. Failure to inquire about sexual function may contribute to poor health care in other areas as well. It is clear that many pharmacological agents are associated with sexual side effects, and these symptoms may explain noncompliance with certain medical treatment programs.5 Even in cases where the pharmacological agents cannot be changed because of life-threatening disease, a frank discussion of this with the patient might engender greater cooperation.
Multiple drugs are frequently assumed to induce sexual dysfunction as an unwanted side effect. In this chapter we review the known mechanisms of sexual function and how the drugs hypothesized to cause sexual dysfunction are thought to interrupt these pathways. The management of drug-induced sexual dysfunction for physicians can be challenging; here we discuss several management strategies for the treatment of drug-induced sexual dysfunction.
The general decline of frequency of sexual activity with age has been consistently documented since it was reported by Kinsey and his colleagues (Kinsey, Pomeroy, & Martin, 1948; Kinsey, Pomeroy, Martin, & Gebhard, 1953). The Kinsey and Hunt (1974) surveys of nonrepresentative samples reported median weekly frequencies of intercourse declining from 2.5 to 3.3 for people aged 16 to 25 to 0.5 to 1 for those aged 46 to 60 (Seidman & Rieder, 1994). Pfeiffer, Verwoerdt, and Davis (1972) investigated 261 White men and 241 White women aged 46 to 71 chosen randomly from membership lists of the local medical group, so that they were broadly representative of the middle and upper socioeconomic levels of the community. Ninety-eight percent of the men and 71% of the women were married. Cessation of sexual intercourse was reported by 14%, 61%, and 73% of women and 0%, 20%, and 24% of men in the age ranges 46 to 50, 61 to 65, and 66 to 71; and frequencies of 2 to 3 or more times a week by 21%, 5%, and 0% of women and 33%, 7%, and 2% of men in these age ranges. Of 91 German women of slightly above average education, cessation of intercourse was reported by 26%, 77%, 79%, and 100% of those in the four age ranges from 50 to 59 to 80 to 91. The percentages in these age ranges without sexual partners were 15, 44, 75, and 92 (von Sydow, 1995).
Although it is a widespread belief that sexual function inevitably declines with aging, it is important for physicians to recognize and affirm that even octogenarians can enjoy an active and fulfilling sex life, provided they are in good physical and mental health. Complaints of sexual dysfunction at any age should prompt a search for disease processes as the cause, but it should be recognized that there are accompaniments to normal aging that can also contribute to the problem (1–5).
Sexual rehabilitation is not a process that begins only after treatment for localized prostate cancer. Men and their partners need some understanding of the sexual consequences of cancer treatment in order to make an informed choice about cancer therapy. Not only have such organizations as the American Cancer Society, the National Prostate Cancer Coalition, and the American Foundation for Urological Diseases worked to increase the public’s knowledge about prostate cancer and recommendations for screening, but they also have encouraged men to participate actively in decision making about their cancer treatment. Compared to just 10 years ago, men now have dozens of books, internet websites, and pamphlets available giving advice on choosing an effective treatment and avoiding complications, such as sexual dysfunction. Many men are aware of publicity about the limited data showing effectiveness of aggressive treatment for prostate cancer, and the advocacy by some physician groups of reduced use of screening and increased use of watchful waiting as a treatment option (1).
In interviewing subjects in order to reach a diagnosis of sexual dysfunction or deviation preliminary to the management of their condition, it is as important to determine the nature of their personalities as it is to diagnose the condition for which they sought help. This information is essential for the second function of the diagnostic interview, the establishment with the subjects of an appropriate therapeutic relationship to maximize their likelihood of remaining in and complying with treatment. Also, the nature of their personality is a major determinant of their response to treatment. In the diagnosis of patients’ complaints, the categories provided by the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R; American Psychiatric Association, 1987) are widely accepted, at least in the published literature, though it is necessary to be aware of their limitations, for which they are undergoing revision (DSM-IV draft criteria; American Psychiatric Association, 1993).
There have not been reports analyzing in detail the reproductive hormone changes in hypogonadal men after usual therapeutic injections of testosterone cypionate (TC). In 11 hypogonadal men 200mg intramuscular TC caused a threefold rise in serum T (peak values, days 2 to 5), a 33% increase in % free T (%FT) (days 2 to 7), and a 4.5-fold rise of absolute FT (peak on days 2 to 3), a 66% increase in % nonsex hormone-binding globulin-bound T (%non-SHBG-T) (peak days 2 to 7), a sixfold increase in absolute non-SHBG-T (peak days 4 to 5), and a threefold rise of estradiol (days 2 to 7). Many of the men achieved androgen concentrations (T, FT, and non-SHBG-T) above the respective normal concentrations between days 2 and 7; then steroid values declined to basal levels by days 13 to 14. Non-SHBG-T showed the largest-fold absolute increase and on day 4 to day 5 averaged three times the mean in normal men. Five men achieved non-SHBG-T values several times the upper limit of our total normal range. Luteinizing hormone became suppressed in men receiving their first intramuscular TC injection and remained suppressed in men receiving chronic TC. Thus, in hypogonadal men, biweekly injections of 200mg TC result in wide variations in circulating androgen levels, from high to elevated shortly after intramuscular TC declining to basal by days 13 to 14.
Infertility and sexual dysfunction in men, specifically erectile dysfunction (ED), are distinct entities that share a complex and interdependent relationship with one another. This chapter discusses the similarities and differences between the etiologies and treatments for each condition and highlights the potential impact infertility may have on male sexual function. It is important to consider these as linked entities during evaluation of affected men and to structure treatment approaches while considering the numerous and varied causes of both ED and male infertility, given the close relationship between the two conditions.
Sexual function decreases markedly with advancing age. In a survey of an outpatient clinic population, Slag et al1 found that one in three patients over 40 years of age had erectile dysfunction. Half of these patients wanted treatment for their impotence. Kinsey et al2 found that the frequency of intercourse decreased from an average of once per week at 65 years of age to once every 10 weeks by the age of 80 years. The reasons for the decline in sexual function with advancing age are multifactorial and include psychological, physiologic, and pathologic processes. The exact role played by each of these processes varies from individual to individual. In addition, a number of changes occur in male hormonal function with advancing age. The effects of these changes on male sexuality are ill defined, and they may also play a role in a number of changes commonly associated with aging, such as decreased muscle strength and osteopenia.
A 68-year-old male was seen in the ambulatory setting at the Ohio State University Hospitals, for general medical evaluation after his primary care provider had retired. He had long-standing Type II diabetes mellitus managed with insulin and an oral agent. He also had moderate systolic hypertension treated with a diuretic and beta blocker. Although he denied any known cardiovascular disease, evaluation of his resting EKG revealed evidence of an inferior myocardial infarction.
Endocrine disturbances can be observed in only a minor group of patients with erectile dysfunction. However, the high success rate of endocrine therapy in these patients and the impact of endocrine disease on their metabolic homeostasis (apart from erectile dysfunction) make the diagnosis of endocrine disturbances an integral part of the total diagnostic approach to impotence.
Impairments of sexual functioning, the dysfunctions, are classified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) in seven categories. Sexual Desire Disorders include Hypoactive Sexual Desire involving deficient (or absent) sexual fantasies and desire for sexual activity, and Sexual Aversion, involving extreme aversion to and avoidance of all or almost all genital sexual contact with a partner. Sexual Arousal Disorders include Female Sexual Arousal Disorder, an inability to attain or maintain an adequate genital lubrication-swelling response of sexual excitement until completion of the sexual activity, and Male Erectile Disorder, an inability to attain or maintain an adequate erection until completion of the sexual activity. Orgasm Disorders include Female and Male Orgasmic Disorders and Premature Ejaculation. Female Orgasmic Disorder is delay or absence of orgasm following a normal sexual-excitement phase. It is pointed out that women vary widely in the type or intensity of stimulation that triggers orgasm and that the diagnosis should be based on the clinician’s judgment that the woman’s orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives. Presumably, such absence of orgasmic capacity would not be accepted as a disorder in such women as those who reported in many surveys that they enjoyed intercourse very much, although they did not reach orgasm (McConaghy, 1993), provided it did not cause marked distress or interpersonal difficulty (Criterion B).
In the past 10 years extensive animal and human studies have begun to clarify the physiology of penile erection. Although there are many questions still unanswered, the evaluation of the impotent patient has reached a level of sophistication that reflects our increased understanding of the pathophysiology of chronic erectile dysfunction.
Sexual dysfunction is common with advancing age;1–4 frequency of sexual intercourse decreases and erectile dysfunction commonly increases with age. However, decline in sexual function (measured as coital activity) is only indirectly associated with advancing age, is not necessarily inevitable, and varies among individuals. Sexual dysfunction arises from psychologic, physiologic, and pathologic causes within one or more of the following categories5,6: (a) sexual appetite or desire; (b) sexual arousal, including erectile dysfunction; (c) orgasmic, including inhibited orgasm and premature ejaculation; and (d) sexual pain disorders. The first two categories are most commonly seen in older individuals. By age 75, at least 50% of men have developed impotence7 Despite these numbers, sexuality is poorly understood and sexual disorders are frequently underdiagnosed and under-treated in older men.
Clinical features associated with aging in men include sexual dysfunction, hypogonadism, and psychological changes. In men, although there is no comparable signal event associated with aging, analogous changes in bone density, lipoproteins, and psychological factors as well as alterations in endocrine status take place. The question of whether these and other changes represent a syndrome, a "manopause," or a "viropause" remains controversial. A syndrome is usually defined as a set of symptoms, signs, and diagnostic features that are all due to a single etiology, e.g., Cushing's syndrome is due to the overproduction of cortisol or administration of excess glucocorticoids. By that definition the manopause is not a syndrome, but neither are some features of the menopause. Perhaps whether a syndrome even exists is not an interesting question. If the manopause is defined to include concomitantly appearing changes that may influence each other and that become apparent in middle age, then it may indeed exist.
Introduction:
Erectile dysfunction (ED) has been identified as the most common sexual problem that affects mainly men older than 40 years. According to this, there is a strong evidence linking ED with a number of medical conditions and related risk factors that had been described in the literature, yet there is limited information about the specific mechanism involved in the establishment of ED among healthy older men.
Aim:
The purpose of this study is to review the literature and mainly focus on the basic physiologic and vascular alterations and morphologic changes related to aging and its related risk factors, summarizing the main and the latest findings in basic research of tissue remodeling process involved in ED pathophysiology.
Methods:
Data from the pertinent literature were examined to inform our conclusions.
Main outcome measure:
This article defines the morphologic and physiologic mechanisms involved in the process of aging, which play a key role in the development of sexual dysfunction.
Results:
ED has been considered as a nonlife-threatening condition, but the recognition of its multiple comorbid conditions, the importance of aging process over the male sexual performance among them its relation with vascular and nitric oxide content alteration, as well as penile morphologic changes, and the fact that it is a widespread under-reported disease, have established the need of an early diagnosis and treatment of this common sexual problem within the general male population.
Conclusion:
In this case, morphologic and physiologic mechanisms that are involved in the aging process play a key role in the development of sexual dysfunction in the absence of any other clinical or medical condition.
Disorders of sexual function in the human result from a remarkable variety of structural lesions involving the nervous system. Sexual dysfunction is widely recognized as a reflection of disorders of the peripheral nervous system and of the spinal cord; however, it is less widely appreciated that lesions of the cerebral hemispheres may also produce changes in this respect, at times so startling, dramatic, or bizarre as to be regarded, albeit inappropriately, as psychogenic in origin. It is tempting to suggest a simple dichotomy in this respect: lesions in the peripheral nervous system might be expected to induce disorders of potency, involving erection, ejaculation, or both, whereas lesions of the central nervous system, and particularly of the cerebral hemispheres, might be anticipated to result in disorders of libido, i.e., of sexual energy and desire. This division may be valid to a point but, as will be seen, does not really hold up to critical scrutiny, and in general, one cannot determine with certainty, on the basis of the type of sexual disorder alone, the site of neural involvement in any given patient.
Aging of the reproductive system in both men and women results in symptoms that frequently require physician assistance, and changes in sexual function with advancing age represent a “hidden” concern of many older patients. Physiologic studies of aging including studies of reproductive aging require special attention to subject selection, characterization, and study design (Rowe, 1977). Failure to consider these factors explains much of the inconsistency in the literature, and careful adherence to study design and subject selection will lead to clarification of the mechanisms accounting for reproductive aging.
As men age, there is a decrease in sexual function. Kinsey et al.1 reported that the frequency of intercourse fell from once per week at age 65 to 0.1 per week by the age of 80. Newman and Nichols2 reported that in married couples aged 60 to 69, approximately 60% were sexually active, while in those over 75 only 26% were still active. Pfeiffer et al.3 reported a significant inverse correlation between age and sexual interest. In their longitudinal study, cessation of sexual intercourse was almost always attributed to the male partner. The Starr-Weiner report of subjects over 60 years of age attending senior centers found that the majority of older subjects enjoyed sex and that about half masturbated.4 In Persson’s study of 70-year-old Swedish males, decreased sexual activity was associated with bereavement, abnormal mental health, low sex drives when younger, and negative attitudes toward sexuality and aging.5
In the last decade, there have been tremendous gains in knowledge concerning the diagnosis and treatment of male erectile dysfunction. Many problems previously felt to be beyond help have responded to current therapeutic approaches. Unfortunately, this new information is not readily available to most clinicians, and most professionals treating erectile problems are poorly prepared to evaluate these complaints. Nonmedical professionals are understandably ill prepared to evaluate and appreciate biological influences on sexual behavior. Many physicians are minimally trained in the evaluation and treatment of patients with complaints of impotence. It is comparatively recently that medical schools have included instruction in the evaluation and treatment of sexual problems.1 With the recent advances in knowledge concerning human sexuality, it is nearly impossible for any subspecialist’s knowledge and clinical experience to encompass all the relevant information concerning the diagnosis and treatment of erectile problems. An additional problem is that the necessary knowledge base cuts across traditional medical subspeciality boundaries. For example, a thorough evaluation of a complaint of impotence might require nocturnal penile tumescence testing in a neurophysiology laboratory, penile blood flow studies in a vascular laboratory, full evaluation of endocrine status, a careful review of the patient’s medical and pharmacological history, a thorough physical examination, as well as a specialized psychiatric interview focusing on sexual behavior and marital interaction.
Sleep plays an important, but often underestimated, role in sexual function throughout life. Beginning with puberty, normal sleep is required for development of the pituitary–gonadal axis. The effect of sleep on sexual function after puberty can be explained partly by the effects of sleep disruption on hormonal abnormalities, especially testosterone regulation. Sleep apnea is a risk factor for sexual dysfunction in both men and women. This chapter will explore how sleep and sleep disruption affects sexual function. In addition, the interactions between sleep and the pituitary–gonadal axis will be discussed.
Objective:
We review the adverse effects on genitourinary and sexual function associated with antidepressants, neuroleptics, lithium, and benzodiazepines, and suggest treatment strategies that may be used for their management.
Method:
This article is based on systematic review of the existing literature, including more than 130 relevant articles on genitourinary and sexual effects of psychotropic medications.
Results:
We find that genitourinary function, including effects on continence and flow, and sexual function, including libido, erection, ejaculation and orgasm, may be altered by psychotropic administration. Many of these effects may be consequent to the impact of these medications on neurophysiologic systems.
Conclusions:
Genitourinary and sexual adverse effects associated with psychotropic therapy are important areas of study and clinical concern that may affect patient comfort and compliance with treatment.
Background: Erectile dysfunction (ED) is a common condition in patients with type 1 or type 2 diabetes mellitus. The prevalence and predictors in our patient population are unknown since minimal data exist for this condition in South Africa. Method: An observational, cross-sectional study was performed on 150 consecutive male patients aged ≥ 50 years, with either type 1 or type 2 diabetes mellitus, attending the Steve Biko Academic Hospital Diabetes Clinic. These patients were evaluated for diabetes mellitus control and medical complications, and for the presence of ED. Morning serum testosterone levels were determined. Results: Some degree of ED was reported in 95% of the patients, with 51% reporting serious dysfunction. Using multivariate logistic regression, it was determined that the significant factors associated with ED were age, body mass index, the peripheral neuropathy score and diuretic therapy. Differences in quality-of-life scores were seen in some ED subgroups. Conclusion: This study confirms the high prevalence of ED in diabetic male patients in a tertiary setting. It is suggested that universal screening should be performed for this population group. Multiple predictors of ED were identified in this study. ED negatively affected quality of life, but not in a statistically significant way.
Cancer patients undergo a crisis period when they learn of their diagnosis. Entering treatment may also prompt yet another stressful time. Most cancer patients, however, do have a good prognosis with a return to their previous lifestyle expected. One life area for which recovery may not bring resumption of normal functioning is sexuality. Depending on the site of disease and treatment received, upwards of 90% of women with cancer may experience substantial sexual disruption (Andersen, 1985). Concern with the sexual problems of cancer patients in general (Derogatis MacDonald, 1982), and women with cancer in particular (Andersen, in press) has been voiced, with the American Cancer Society (1987) and the National Institutes of Health (1987) targeting sexual functioning morbidity as an important concern in psychological research with cancer patients.
Impotence in not a concomitant of aging. A diligent search must be undertaken to determine the cause, which may be endocrine, pharmacologic, vascular, neurologic, psychological, or miscellaneous (eg, chronic illness). Many therapies are available for elderly impotent men. Some are based on pharmacology (eg, testosterone supplementation, thyroid replacement, self-injection), some on surgery (eg, vascular reconstruction), and some on a prosthesis (semirigid, inflatable, or mechanical). In choosing the type of treatment, the physician must consider the patient's underlying medical condition, activities of daily living, social life, and partner's expectations in addition to the cause of the impotence.
This Book Describes the Diseases of the Kings: King Saul, King David, King Asa, King Jehoram, King Hezekiah, King Uzziah, and King Elah and covers: Bipolar I disorder * Suicide * Major depression * Blindness * Osteoporosis * Hypothermia * Carcinoma of prostate or kidney with metastases to the bones * Malnutrition * Cachexia * Anemia of chronic disease * Pressure ulcers * Sexual dysfunction * Peripheral vascular disease * Colorectal carcinoma * Cutaneous anthrax * Leprosy * Leishmaniasis * Alcoholic intoxication *
During the last two decades, significant advances have been made in the understanding of male sexual dysfunction. Concomitantly, a marked increase in both clinical and research activity in the field of male erectile dysfunction has led to a better evaluation and more treatment options. The prevalence and incidence are dependent on the definitions used, the diagnostic tolls, and the treatment options. Using standard definitions as suggested by the NIH Consensus Conference and improving our diagnostic and treatment options will have a major impact on the epidemiology of ED. A summary of the risk factors for ED is presented in Table 3. Still more epidemiologic research is essential to further understand the distribution as well as the prevalence of ED in certain ethnic groups, chronic conditions, and as a result of surgery and trauma. These studies will help us improve our diagnostic skills as well as our therapeutic options.
The purpose of this chapter is to review pharmacological effects on male erectile dysfunction. As will be documented in this chapter, a wide variety of pharmacological agents have been reported to have sexual side effects. Drugs may influence male sexual function at various levels including (1) sexual interest or desire (also termed libido), (2) the capacity to achieve and maintain an erection sufficient for coitus, (3) ejaculation, and (4) fertility. Although the issue of fertility is beyond the scope of this review, drugs that inhibit fertility often suppress hormonal secretions and may thus influence sexual behavior. This text is concerned primarly with erectile function. However, libido and ejaculation problems often coexist and interact with erectile problems. The effects of drugs on these sexual activities will also be reviewed.
Historically, erectile dysfunction (ED), as all sexual dysfunctions, has been relegated to a lower priority in a busy primary care practice. However, it is becoming evident that ED will not only accompany disease states of high comorbidity, but also can serve as an early marker for some patients presenting without established cardiovascular disease. What follows is an examination of trends of sexual inquiry in primary care practice and why asking about erectile dysfunction should be vital; how to engage a patient to allow for such a discussion; the workup, treatment, and determination of organic erectile dysfunction; how to manage the nonresponder to PDE5i therapy; and when to refer. It is the hope of the authors that sexual inquiry can become standard in primary care practice. The number of men with ED is increasing by the decade, and it is vital to propose both a workup and a treatment plan, that is, not only simple but also includes basic lifestyle changes that address diet and exercise. The chapter will include the optimization of PDE5i therapy, and will review other pharmacologic and surgical therapies.
Sexuality and sensuality contribute to a person's self-concept, which influences self-esteem and relationships with others throughout life. There are many myths surrounding ageing and sexuality fuelled by assumptions that libido and sexual needs decline along with the loss of culturally valued signs of beauty or handsomeness. By 75–85 years of age, only one-quarter of the population is sexually active; the reasons for this are many and include psychosocial factors such as loss of a partner, age-related physiological changes and illness. In older women, the major problems are reduced libido, poor lubrication and inability to climax. In males, erectile dysfunction is the central problem. Health problems are the major reason for a decline in sexuality with ageing. Drugs for the management of erectile dysfunction (phosphodiesterase-5 inhibitors) and new delivery systems to treat low libido (patches, nasal, gels, injections of testosterone) are revolutionizing sexuality in older persons. There is increased awareness of the special needs of the older homosexual. Paraphilias are life-long and do not necessarily disappear with ageing. Management of inappropriate and aggressive sexual behaviours in older persons with dementia is a major problem.
Erectile dysfunction is a common problem, affecting more than half of all men between the ages of 40 and 70 years. The authors' goal was to quantify the prevalence of concomitant erectile dysfunction and active depression among patients seen in a general medical setting between September 1998 and September 1999. Simple random sampling techniques were used to select a subset of 334 patients from 73 general medical practices affiliated with an academic tertiary referral center in Pennsylvania. Of the 334 patients sampled, the authors received responses from 268 subjects (80.2%) and completed questionnaires from 199 subjects (59.6%) with a mean age of 59 years. The survey instrument consisted of three major sections: demographic and health history information, the Center for Epidemiologic Studies Depression (CES-D) Scale, and the five-item version of the International Index of Erectile Function Scale. The prevalence of moderate or complete erectile dysfunction in this sample was 36.4% (95% confidence interval (Cl): 29.6, 43.1). The prevalence of current depression by CES-D Scale criteria was 12.1% (95% Cl: 7.5, 16.7), and the prevalence of concomitant erectile dysfunction and depression was 5.1% (95% Cl: 2.0, 8.1). Using logistic regression, the authors found that current depressive symptoms were not associated with moderate or complete erectile dysfunction (odds ratio = 1.3, 95% Cl: 0.5, 3.1; p = 0.565). Concomitant erectile dysfunction and depression represent a significant public health problem.
“O Venus, cruel mother of amorous desires, cease attempting to bring under your yoke a man now arrived at his fiftieth year, and therefore stubborn to submit to your voluptuous commands.”
To Venus
Horace (68 BC)
ResearchGate has not been able to resolve any references for this publication.