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Introduction. No reported studies exist assessing the relationship between sexual function and hyperlipidemia in women. Aim. In this study, we assessed the domains of sexual function in a representative sample of sexually active premenopausal women with hyperlipidemia, but without cardiovascular disease, as compared with an age-matched female population without hyperlipidemia. Methods. To be enrolled in the study, women had to meet at least one of the following criteria for the diagnosis of hyperlipidemia: low-density lipoprotein (LDL) cholesterol levels >160 mg/dL; high-density lipoprotein (HDL) cholesterol levels <50 mg/dL; or triglyceride levels >150 mg/dL. Lipid parameters were assessed and verified on blood taken at least twice in the hospital during the screening phase. Four hundred forty-one premenopausal women with hyperlipidemia were compared with 115 age-matched premenopausal women without hyperlipidemia. Main Outcome Measures. We used the Female Sexual Function Index (FSFI) for assessing the key dimensions of female sexual function. Results. The two groups were well matched for age and smoking prevalence. Compared with women of the control group, women with hyperlipidemia had reduced mean global FSFI score (22.8 ± 6.8 vs. 29.4 ± 4.9, P < 0.001). Individual analysis of the different domains showed that women with hyperlipidemia reported significantly lower arousal, orgasm, lubrication, and satisfaction scores than control women. Based on the total FSFI score, 51% of women with hyperlipidemia had scores of 26 or less, indicating sexual dysfunction, as compared with 21% of women without hyperlipidemia ( P < 0.001). Based on a more conservative analysis including women under the lower quartile of the distribution of FSFI score, 32% of women with hyperlipidemia had scores of 23 or less, as compared with 9% of women without hyperlipidemia ( P < 0.001). Multiple regression analysis identified age, body mass index, HDL-cholesterol and triglycerides as independent predictors of FSFI score. Conclusions. Women with hyperlipidemia have significantly lower FSFI-domain scores as compared with age-matched women without hyperlipidemia. HDL cholesterol and triglyceride levels were independently associated with the FSFI score. Esposito K, Ciotola M, Maiorino MI, Giugliano F, Autorino R, De Sio M, Cozzolino D, Saccomanno F, and Giugliano D. Hyperlipidemia and sexual function in premenopausal women. J Sex Med 2009;6:1696–1703. [ABSTRACT FROM AUTHOR]

Introduction. Limited data are available supporting the notion that treatment of lifestyle risk factors may improve erectile dysfunction (ED). Aim. 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. Methods. 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. Main Outcome Measures. 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. Results. 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. Conclusions. 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. Esposito K, Ciotola M, Giugliano F, Maiorino MI, Autorino R, De Sio M, Giugliano G, Nicoletti G, D'Andrea F, and Giugliano D. Effects of intensive lifestyle changes on erectile dysfunction in men. J Sex Med 2009;6:243–250. [ABSTRACT FROM AUTHOR]

Introduction. Bone marrow-derived endothelial progenitor cells (EPCs) circulate in the peripheral blood and are involved in endothelial homeostasis and repair. Aim. The aim of this study was to assess the circulating levels of different EPC phenotypes in overweight men with or without erectile dysfunction (ED). As endothelial dysfunction is considered a necessary link with ED, endothelium-dependent vasodilation and its relation with EPCs were also investigated. Methods. We studied 30, otherwise healthy, overweight subjects with symptomatic ED for at least 6 months, and 30 age- and weight-matched subjects without ED. Erectile function was assessed by completing the International Index of Erectile Function (IIEF-5), which consists of items 5, 15, 4, 2, and 7 from the full-scale IIEF-15. Main Outcome Measures. Seven subpopulations of EPCs were determined by flow cytometry on the basis of the surface expression of CD34, CD133, and KDR antigens: CD34+, CD133+, KDR+, CD34+CD133+, CD34+KDR+, CD133+KDR+, and CD34+CD133+KDR+. Endothelium-dependent flow-mediated dilation (FMD) was evaluated in the right brachial artery with a high-resolution ultrasound machine following reactive hyperemia. Results. CD34+KDR+ cell count was significantly lower in men with ED as compared with men without ED (63.1 ± 4 vs. 92.4 ± 6 cells/106 events, mean ± standard error, P < 0.01). There was a significant direct correlation between circulating CD34+KDR+ cells and the IIEF score ( r = 0.44; P = 0.01): men with the severe form of ED presented the lowest level of circulating EPC CD34+KDR+ cells. No significant correlation was found between the circulating levels of the other EPC phenotypes and the IIEF score. There was a significant correlation between CD34+KDR+ cell count and FMD ( r = 0.45; P = 0.01), but not between FMD and the other phenotypes. Conclusions. Circulating levels of CD34+KDR+ EPC are reduced in overweight subjects with ED and correlate with the severity of ED. Other EPC phenotypes are not related to ED, suggesting that the CD34+KDR+ phenotype of EPCs may be preferred in future studies. Esposito K, Ciotola M, Maiorino MI, Giugliano F, Autorino R, De Sio M, Jannini E, Lenzi A, and Giugliano D. Circulating CD34+KDR+ endothelial progenitor cells correlate with erectile function and endothelial function in overweight men. J Sex Med 2009;6:107–114. [ABSTRACT FROM AUTHOR]

Introduction. Endothelial microparticles (EMPs) may play a role as biomarkers of vascular injury. EMPs are higher in men with diabetes diabetic men with erectile dysfunction (ED) than in nondiabetic potent men. Aim. The aim of this study was to quantize different phenotypic circulating EMP levels among diabetic and nondiabetic patients with ED, and to determine whether EMPs are released as a result of activation or apoptosis. Methods. We studied 30 type 2 diabetic and 24 nondiabetic subjects with symptomatic ED from at least 6 months, and 20 nondiabetic men without ED matched for age and weight with diabetic and nondiabetic subjects. Erectile function was assessed by completing the International Index of Erectile Function (IEEF)-5, which consists of Items 5, 15, 4, 2, and 7 from the full-scale IIEF-15. A score of 21 or less indicates the presence of ED. Main Outcome Measures. EMP levels in plasma were quantified by flow cytometry. Markers for apoptosis (platelet/endothelial cell adhesion molecule 1/CD31 antigen) and activation (E-selectin/CD62E antigen) were compared. Endothelium-dependent flow-mediated dilation (FMD) was evaluated in the right brachial artery with a high-resolution ultrasound machine following reactive hyperemia. Results. Diabetic patients were found to have the highest levels of EMP31+; diabetic and nondiabetic men with ED were found to have significantly higher levels of EMP62+ than nondiabetic men without ED. The EMP62/EMP31 ratio, an index of endothelial activation (high ratio) or apoptosis (low ratio), was lowest in diabetic men with ED (0.20). In the whole group of 54 men with ED (diabetic and nondiabetic), there was an inverse correlation between FMD and the number of circulating EMPs ( P < 0.05). Conclusions. The presence of diabetes in subjects with ED is associated with a different pattern of endothelial cell injury. The phenotypic assessment of EMPs in diabetic patients with ED is consistent with increased apoptotic activity. Esposito K, Ciotola M, Giugliano F, Sardelli L, Maiorino MI, Beneduce F, De Sio M, and Giugliano D. Phenotypic assessment of endothelial microparticles in diabetic and nondiabetic men with erectile dysfunction. J Sex Med 2008;5:1436–1442. [ABSTRACT FROM AUTHOR]

Introduction. Female sexual dysfunction (FSD) is a significant public health problem. There are no reported studies assessing the relation between sexual function and neuropathy in women, except for diabetes mellitus. Aim. The aim of this study was to explore the correlations between peripheral and autonomic neuropathy, and Female Sexual Function Index (FSFI) among nondiabetic women with or without FSD. Methods. During a 6-month period, women were screened among outpatients seeking routine weight loss help. Cases were women, either pre- or postmenopausal, with abnormal values of FSFI score; controls were women from the same population with normal values of FSFI score, matched with cases for age and menopausal status. The total score range was 2–36; a score of 23 or lower indicated sexual dysfunction. The tool was administered during the follicular (days 5–8) phase of the menstrual cycle. Main Outcome Mesures. The assessment of peripheral neuropathy was based on the quantitative sensory examination using the vibratory, thermal, and pain sensory thresholds. The assessment of autonomic neuropathy was based on cardiovascular reflex tests (deep breathing and squatting). Results. The results of the quantitative sensory testing examination showed pathological changes in about 20% of women with FSD; the tests were abnormal in about 5% of women in the group without FSD. The percentage of women with abnormalities of autonomic cardiovascular tests was higher in the group with FSD compared with the group without FSD. Conclusions. Our results suggest an involvement of both somatic and autonomic nerve fibers in nondiabetic women with FSD. Esposito K, Ciotola M, Giugliano F, Carleo D, Schisano B, Maglione E, Di Tommaso D, De Sio M, and Giugliano D. Quantitative sensory and autonomic testing in nondiabetic women with sexual dysfunction. J Sex Med 2007;4:1367–1372. [ABSTRACT FROM AUTHOR]