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Objectives: We aimed to study the risk factors of erectile dysfunction (ED) and different patterns of phosphodiestrase type 5 inhibitors (PDE5is) usage among Egyptian patients., Patients and Methods: One thousand five hundred consecutive Egyptian patients complaining of ED were included in this cross-sectional study from July (2014) to October (2015). Patients were requested to answer the international index of erectile function questionnaire (IIEF-5). Statistical differences between groups were tested using Chi square test and Spearman's rho correlation coefficient for qualitative variables., Results: Remarkably, significant associations between IIEF scores and aging and diabetes mellitus (DM) and hypertension (HTN) and ischaemic heart disease (IHD) and hyperlipidaemia were shown in the studied patients (p<.0001, p<.0001, p<.0001, p<.0001, p<.0001, respectively). Eventually, our study showed significant correlations between different age groups and morning erection and lower urinary tract symptoms and HTN and IHD and DM where the severity of ED was directly proportional to the absence or decreased strength of morning erection with aging and the increased incidence of LUTS and HTN and IHD and DM with aging (p<.0001; p=.001; p<.0001; p<.0001; p<.0001, respectively)., Conclusion: Our study demonstrated that aging; DM, HTN and hyperlipidaemia are potential major risk factors of ED in Egypt for further validation. In addition, most of the participants used PDE5is without prior medical consultation together with concomitant administration of illicit drugs., (Copyright © 2020 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

Abstract: Erectile dysfunction is a common entity in clinical practice. Primary erectile dysfunction, not related to vasculopathy or psychiatric disorder, can be readily treated with phosphodiesterase inhibitors. These drugs have many physiologic effects that can alter a patient's hemodynamic profile considerably, especially in the presence of concomitant structural heart disease, specifically valvular heart disease. Although some contraindications to the use of PDE5 inhibitors in patients with cardiovascular disease are defined, the effect of these drugs in the presence of valvular heart disease is not well documented. The purpose of this review is to analyze the data regarding the safety of PDE5 inhibitors in patients with valvular heart disease., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Erectile dysfunction (ED) is associated with testosterone deficiency and is a symptom of functional hypogonadism. A correlation between ED and cardiovascular disease (CVD) has been recognized, and ED has been proposed as an early marker of CVD. However, the relationship between ED and CVD risk in hypogonadism requires clarification and whether testosterone therapy (TTh) can be a beneficial treatment strategy, but long-term data are limited. This study investigates long-term TTh in men with hypogonadism and ED with a history of CVD., Methods: Seventy-seven patients with a history of CVD and diagnosed with functional hypogonadism and erectile dysfunction (erectile function domain score <21 on the International Index of Erectile Function questionnaire (IIEF questions 1-5)) were enrolled and TTh effects on anthropometric and metabolic parameters investigated for a maximum duration of 12 years. All men received long-acting injections of testosterone undecanoate at 3-monthly intervals. Eight-year data were analysed. Data collection registry started in November 2004 till January 2015., Results: In hypogonadal men receiving TTh, IIEF increased by 5.4 (p<0.001). Total weight loss was 23.6 ± 0.6 kg after 8 years. HbA1c had declined by an average of 2.0% (P<0.0001). Total cholesterol levels significantly declined following TTh after only 1 year (P<0.0001), and HDL increased from 1.6±0.5 at baseline to 2±0.5 mmol/L following 8 years of TTh (P<0.0001). SBP decreased from 164±14 at baseline to 133±9 mmHg, signifying a reduction of 33±1 mmHg (P<0.0001)., Conclusion: In hypogonadal men with a history of CVD, TTh improves and preserves erectile function over prolonged periods with concurrent sustained improvements in cardiometabolic risk factors. Measuring ED and testosterone status may serve as an important male health indicator predicting subsequent CVD-related events and mortality and TTh may be an effective add-on treatment in secondary prevention of cardiovascular events in hypogonadal men with a history of CVD., Competing Interests: Prof. Dr Aksam Yassin reports grants from Bayer AG, during the conduct of the study; personal fees from honoraria, generally, outside the submitted work. Prof. Dr Farid Saad reports personal fees from Bayer AG, during the conduct of the study and outside the submitted work; and owns shares of Bayer AG, Berlin, Germany. The authors report no other potential conflicts of interest for this work., (© 2021 Alwani et al.)

Background: Erectile dysfunction (ED) is a major health problem that affects a significant proportion of the general population, and its prevalence is even higher in patients with CV risk factors and/or disease. ED and cardiovascular (CV) disease share several common pathophysiological mechanisms, and thus, the potential role of ED as a predictor of CV events has emerged as a significant research aspect., Objective: The purpose of this review is to present and critically discuss data assessing the relation between ED and CV disease and the potential predictive value of ED for CV events., Methods: A comprehensive review of the literature has been performed to identify studies evaluating the association between ED and CV disease., Results: Several cross-sectional and prospective studies have examined the association between ED and CV disease and found an increased prevalence of ED in patients with CV disease. ED was shown to independently predict future CV events. Importantly, ED was found to precede the development of overt coronary artery disease (CAD) by 3 to 5 years, offering a "time window" to properly manage these patients before the clinical manifestation of CAD. Phosphodiesterase type 5 inhibitors are the first-line treatment option for ED and were shown to be safe in terms of CV events in patients with and without CV disease., Conclusion: Accumulating evidence supports a strong predictive role of ED for CV events. Early identification of ED could allow for the optimal management of these patients to reduce the risk for a CV event to occur., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: The purpose of the study was to evaluate the association between alcohol consumption and risk of erectile dysfunction (ED)., Methods: PubMed was searched for reports published before June 2019. Data were extracted and combined odds ratios (ORs) calculated with random-effects models., Results: Finally, 46 studies were included (216,461 participants). The results of our meta-analysis indicated that there was a significant association between regular alcohol consumption and ED (OR 0.89, 95% confidence interval [CI]: 0.81-0.97). There was no indication of publication bias (Egger's test, p = 0.37). In the stratified analysis, the pooled OR of ED for light to moderate and high alcohol consumption was 0.82 (95% CI: 0.72-0.94) and 0.82 (95% CI: 0.67-1.00), respectively. No variable related to the source of heterogeneity was found in univariate and multivariate meta-regression analyses. A dose-response meta-analysis suggested that a nonlinear relationship between alcohol consumption and risk of ED was observed (p for nonlinearity <0.001)., Conclusion: A J-shaped relationship between alcohol consumption and risk of ED was observed. Alcohol should be taken in moderate quantities in order to obtain the dual effect of disinhibition and relaxation. If taken chronically, it could provoke vascular damages., (© 2021 S. Karger AG, Basel.)

Purpose: To identify risk factors and potential predictors of erectile dysfunction (ED) in type-2 diabetes mellitus (T2DM) patients for early detection and treatment., Methods: A retrospective cohort was used to assess the clinical data of 105 diabetic patients with ED from May 2019 to April 2020 age-matched to 105 diabetic patients without ED. Potential risk factors that could contribute to ED were compared between the groups. Erectile function was evaluated using the International Index of Erectile Function-5 questionnaire., Results: There were higher rates of diabetic peripheral neuropathy (p = 0.036) and retinopathy (p < 0.001), longer duration of diabetes (p < 0.001), lower estimated glomerular filtration rate (p = 0.010) values, and higher uric acid (p < 0.001) and C-reactive protein (p = 0.001) levels in the ED group compared to the non-ED group. Multivariate logistic analysis identified uric acid, diabetic retinopathy, and T2DM course as independent predictors of diabetic ED. Diabetics with retinopathy and T2DM for ≥49 months were 3.028 and 3.860 times more likely to have ED, respectively. Uric acid values ≥392.5 μmol/L were associated with 18.638 times greater risk of having ED, though the values were within normal range., Conclusion: In T2DM patients, higher uric acid (≥392.5 μmol/L), longer diabetes duration (≥49 months), and the presence of diabetic retinopathy were important and reliable predictors for diabetic ED. For patients who have high risk factors for developing ED, diligent screening and early treatment are necessary., (© 2021 S. Karger AG, Basel.)

Aims: To investigate whether metabolic syndrome (MetS) is associated with erectile dysfunction (ED) among apparently healthy men when depressive symptoms and serum testosterone levels are taken into account., Methods: A study population of 549 men at risk for cardiovascular disease or type 2 diabetes was drawn from the participants of a population survey, the Harmonica Project. MetS was diagnosed with the United States National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) 2005 definition, the International Diabetes Federation (IDF) 2005 definition and the Harmonization 2009 definition. ED was evaluated by the International Index of Erectile Function (IIEF-5) questionnaire. Depressive symptoms were assessed with Beck's Depression Inventory (BDI)., Results: Of the 549 men (mean age 58.4 ± 6.7 years), 56.5 % reported ED. The prevalence of MetS was 48.6%, 35.5%, and 50.6% according to the IDF, the ATPIII, and the Harmonization criteria, respectively. We found no difference in the prevalence of ED between men with or without MetS. In a multivariate analysis, age, presence of depressive symptoms and lower education were significant predictors of ED., Conclusions: The prevalence of ED is quite high even in apparently healthy men. Depressive symptoms are a critical component to consider in men suffering from ED., (Copyright © 2019 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Objective: To characterize themes of discussion and specific concerns expressed by users of an internet erectile dysfunction (ED) community using a mixed-methodology approach involving quantitative natural language processing (NLP) and qualitative annotation of content., Methods: We extracted posts and responses from the Reddit community r/ErectileDysfunction (3100 members) during June 2018 to May 2019. We applied an NLP technique called the meaning extraction method with principal component analysis to computationally identify themes of discussion. We manually annotated a subset (30%) of posts based on NLP-derived themes to evaluate specific content., Results: We analyzed 329 posts and 1702 responses. Meaning extraction method with principal component analysis identified key themes: hypogonadism symptoms, masturbation/sex, evaluation/treatment, alternative therapies, and partner factors (posts); and performance anxiety, hypogonadism evaluation, pornography, and pharmacotherapy (responses). Subset annotation of 100 posts revealed a median author age of 24 years (Interquartile Range (IQR): 20-31). 48% of discussants believed their ED was psychogenic, 38% reported depressive symptoms, and 2% mentioned self-harm/suicidality either attributed to or associated with their ED. 28% of discussants reported seeing a health care professional for ED, and 20% attempted abstinence from pornography/masturbation as a self-prescribed intervention., Conclusion: Social media platforms like Reddit empower young men to discuss ED concerns. Fewer than one-third reported seeing a doctor for ED, suggesting that men turn to peers on the internet first, despite risk of misinformation. A majority attributed symptoms to psychological etiologies and excess pornography/masturbation. Depression, self-harm, and suicide emerged as potent concerns. These data underscore the importance of engaging proactively with young men, both in the consultation room and online., (Copyright © 2020 Elsevier Inc. All rights reserved.)

: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.

Erectile dysfunction (ED) is defined as a man's consistent or recurrent inability to attain and/or maintain penile erection enough for successful vaginal intercourse. ED affects a large part of the population, increasing its incidence with age and comorbidities. It is estimated by the year 2025, 322 million men will suffer from ED. Incidence of ED has been related not only to chronic diseases such as diabetes mellitus, metabolic syndrome, hyperlipidemia, psychiatric diseases or urinary tract diseases, but also to hypertension and especially to antihypertensive treatments. This review summarizes current knowledge about the management of ED in hypertensive men and its role as cardiovascular disease predictor., Competing Interests: Dr Alberto Cordero reports honoraria for lectures from AstraZeneca, Bristol-Myers Squibb and AMGEN; and consulting fees from AstraZeneca, Ferrer and AMGEN. The authors report no other conflicts of interest in this work., (© 2020 Hernández-Cerda et al.)

Purpose: We analyzed the rate of preserved potency after prostate brachytherapy (PB) with radioactive seeds and the impact of patient comorbidities on post-PB erectile dysfunction (ED)., Methods: We included 627 patients who were assessed for pre- and postimplant potency between 2005 and 2017. Assessment was based on the Common Terminology Criteria for Adverse Events Scale (CTCAEs). Logistic regression models were used to assess clinical predictors of preserved potency after PB defined as having sufficient erections for sexual activity with or without the need of oral pharmacologic assistance. Covariates included age, diabetes (DM), hypertension (HTN), dyslipidemia (DLP), coronary artery disease (CAD), International Prostate Symptom Score (IPSS), prostate volume, and Cancer of the Prostate Risk Assessments (CAPRA) score. Patients on androgen deprivation therapy or using five alpha reductase inhibitors were excluded from analyses., Results: Post-PB potency was assessed at an average of 6 months (n = 627), 1 year (n = 538), 2 years (=440), 4 years (n = 272), and 5 years (n = 124). At 2 and 5 years, post-PB potency was preserved in 87% and 84% of patients, respectively. When adjusting for all available covariates, advanced age, pre-PB potency, and the presence of vascular comorbidities (HTN, DM, and DLP) were all predictors of potency at 2 years after PB (all p < 0.01). When performing a sensitivity analysis for vascular comorbidities, the presence of DM had the strongest impact on ED than either HTN or DLP (p < 0.01)., Conclusion: More than 84% of patients had preserved potency 5 years after PB. Advanced age, pre-PB potency, and vascular comorbidities had a statistically significant impact on potency after PB., (Copyright © 2019 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

It is an interesting clinical phenomenon that when evaluating the erectile function of men with erectile dysfunction by couples, respectively, using the erectile hardness model, there will exist the evaluation difference between men and their female partners. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. To explore the influencing factors associated with this clinical phenomenon, we conducted this interesting, observational, and cross-sectional field survey. We enrolled 385 couples from the andrology clinics of the first affiliated hospital of Anhui Medical University from December 2017 to December 2018. The demographic data of couples, the medical history, sexuality and the characteristics of ED, and anxiety and depression of the couples were collected through face-to-face interview and questionnaires. The couples were divided into two groups containing 238 couples and 147 couples, respectively. We divided couples into difference group including couples which have inconsistent evaluation results from touching the erectile hardness model and no difference group including couples which have consistent evaluation results from touching the erectile hardness model, respectively. The difference group where the couples share different evaluation results reported higher erectile hardness grade from men than from their female partners (male > female: 73.11% vs . male < female: 26.89%). The scores of IIEF-5 in difference group and no difference group are 13.43 ± 5.75 and 16.82 ± 8.23, respectively. The average grades evaluated from men and women in difference group are 2.79 ± 0.85 and 2.45 ± 0.63, respectively. The average grades evaluated from couples in no difference group are 3.02 ± 0.45. Through statistical comparison and logistic regression analysis, duration of ED > 16 months, seeking treatment from female, negative communication state, and depression from men are the relevant factors accounting for the different evaluation results. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. As for couples with these risk factors, we cannot focus only on the oral medication which only restores the penile erectile function. More importantly, we must combine the sexual counseling and sexual knowledge education with the drug treatment. When the two treatments are tightly integrated, not only the penile erection but also the gap of couples can be restored which is the best result of the ED treatment., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Jingjing Gao et al.)

Introduction: Given the number of confounders in predicting erectile function recovery after radical prostatectomy (RP), a nomogram predicting the chance to be functional after RP would be useful to patients' and clinicians' discussions., Aim: To develop preoperative and postoperative nomograms to aid in the prediction of erectile function recovery after RP., Main Outcome Measures: International Index of Erectile Function (IIEF) erectile function domain score-based erectile function., Methods: A prospective quality-of-life database was used to develop a series of nomograms using multivariable ordinal logistic regression models. Standard preoperative and postoperative factors were included., Main Outcome Measures: The nomograms predicted the probability of recovering functional erections (erectile function domain scores ≥24) and severe erectile dysfunction (≤10) 2 years after RP., Results: 3 nomograms have been developed, including a preoperative, an early postoperative, and a 12-month postoperative version. The concordance indexes for all 3 exceeded 0.78, and the calibration was good., Clinical Implications: These nomograms may aid clinicians in discussing erectile function recovery with patients undergoing RP., Strengths & Limitations: Strengths of this study included a large population, validated instrument, nerve-sparing grading, and nomograms that are well calibrated with excellent discrimination ability. Limitations include current absence of external validation and an overall low comorbidity index., Conclusions: It is hoped that these nomograms will allow for a more accurate discussion between patients and clinicians regarding erectile function recovery after RP. Mulhall JP, Kattan MW, Bennett NE, et al. Development of Nomograms to Predict the Recovery of Erectile Function Following Radical Prostatectomy J Sex Med 2019;16:1796-1802., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Previous studies investigating the risk of erectile dysfunction (ED) among patients with gout have produced inconsistent evidence. Therefore, the aim of this meta-analysis was to investigate the relationship between gout and the risk of ED. The Embase, Medline, Scopus, Web of Science and Cochrane Library databases were searched for all studies assessing the risk of ED in patients with gout. Relative risks (RR) and corresponding 95% confidence intervals (CI) were adopted to estimate the association between gout and the risk of ED. Sensitivity analyses were applied to evaluate the robustness of results. Overall, 355,761 participants were included from 8 studies (3 cross-sectional and 5 cohort studies). Of these, 85,067 were patients with gout. Synthesis results showed patients with gout had a 1.2-fold higher risk of ED than individual without gout (RR 1.20, 95% CI 1.10-1.31, P < 0.001). The results of sensitivity analysis are consistent with the trend of synthesis results. The present meta-analysis revealed that the risk of ED in patients with gout was dramatically increased when compared with the general population, which suggests that clinicians should assess erectile function when treating an individual who suffers from gout.

Patients with cardiovascular disease (CVD) frequently have erectile dysfunction (ED) because the two conditions have similar risk factors and potential mechanisms. The therapeutic effect of CVD is strongly dependent upon long-term management of the condition. Patients with CVD tend to have poor medication compliance, and the coexistence of ED often discourages patients with CVD from continuing their long-term CVD management, thus worsening CVD treatment compliance. The two major reasons for poor compliance are that (i) the adverse effects of cardiovascular medications on erectile function drive people to reduce the prescribed dosage or even stop taking the medications to obtain satisfactory sexual arousal and (ii) a worsening mental state due to ED reduces medication compliance. The regular administration of phosphodiesterase-5 inhibitors (PDE5is) guarantees that the prescribed medication dosages are easy to comply with and that they improve the mental status of patients by enhancing their erectile function, resulting in improved long-term management of CVD through medication compliance. PDE5is themselves also play a role in reducing cardiovascular events and improving the prognosis. We recommend prescribing PDE5is for ED and suggest that PDE5i administration is a promising strategy to improve the long-term management of patients with both ED and CVD.

Introduction: Despite evidence to the contrary, a number of advocacy and self-help groups persist in claiming that internet pornography use is driving an epidemic of erectile dysfunction (ED)., Aim: The present work sought to explore whether mere pornography use itself and self-reported problematic use of pornography are related to ED, both cross-sectionally and longitudinally., Methods: A series of 3 samples of sexually active men who also used pornography were collected: a cross-sectional sample of undergraduate men in the United States (n = 147), an online sample of men derived from a larger sample that was matched to U.S. nationally representative norms (n = 297), and a 1-year, 4-wave longitudinal sample of adult men derived from an online convenience sample (Mechanical Turk: time 1, n = 433; time 2, n = 223; time 3, n = 202; time 4, n = 196). Pearson correlations and cross-sectional structural equation models were conducted in each sample. Latent growth curve analyses were conducted in the longitudinal sample., Main Outcome Measure: The primary outcomes of interest were cross-sectional and longitudinal reports of erectile functioning as measured by the International Index of Erectile Functioning 5., Results: Across all 3 samples, there was evidence of a positive, cross-sectional association between self-reported problematic use and ED, but no consistent association between mere use itself and ED. In our longitudinal sample, there were correlations among baseline pornography use, baseline self-reported problematic use, and prospective ED at times 2-4; however, latent growth curve analyses demonstrated no significant relationships between any pornography-related variables and trajectories of ED., Clinical Implications: These results suggest that among non-treatment-seeking pornography users, self-reported problematic use likely is associated with concurrent reports of ED, but that the links between these variables are not directional or causal in nature., Strength & Limitations: This work is the first work to systematically examine the links between self-reported problematic use of pornography and ED, and it did so in a variety of samples, using both cross-sectional and longitudinal methods. Even so, the work relied exclusively on self-report methods, and did not control for medical covariates that may be related to the experience of ED., Conclusion: In conjunction with prior literature, we conclude that there is little or no evidence of an association between mere pornography use and ED, consistent evidence of an association between self-reported problematic use and ED cross-sectionally, and no evidence of causal links between any pornography variables and ED. Grubbs JB, Gola M. Is Pornography Use Related to Erectile Functioning? Results From Cross-Sectional and Latent Growth Curve Analyses. J Sex Med 2019;16:111-125., (Copyright © 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To report long term outcomes of selective arterial embolization for nonischemic priapism on erectile function utilizing validated outcome questionnaires after selective arterial embolization., Materials and Methods: Twenty men, mean age of 36 years (range: 8-58 years), underwent selective penile embolization for nonischemic priapism between December 1997 and February 2016 (218 months). Each identified case of nonischemic priapism was embolized using gelatin sponge, autologous blood clot, platinum microcoils, polyvinyl alcohol particles, or a combination of these. A variety of procedural details, immediate complications, recurrence of nonischemic priapism, post-procedure performance on Sexual Health Inventory for Men and International Index of Erectile Function Questionnaires, and follow-up duration were recorded., Results: Mean time from development of symptoms until treatment was 117 days (range: 1-1,042 days). After selective arterial embolization, nonischemic priapism resolved in 18 (90%) patients. No patients with successful treatment of their nonischemic priapism developed a recurrence of nonischemic priapism during the study period following the initial treatment. Eight (40%) patients experienced ischemic priapism following embolization with 4 (50%) resolving after treatment. Mean post-procedure Sexual Health Inventory for Men score was 22.1 (range: 16-25). Mean post-embolization erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains on the International Index of Erectile Function were 25.8 (range: 16-30), 7.8 (range: 6-10), 7.4 (range: 5-10), 10.9 (range: 6-14), and 7.9 (range: 6-10), respectively. Mean follow-up was 4,601 days (range: 970-6,711 days)., Conclusion: Resolution of nonischemic priapism following selective arterial embolization occurred in 90% of the patients. Two validated questionnaires showed no erectile dysfunction following treatment. Mild orgasmic dysfunction, sexual desire dysfunction, intercourse dissatisfaction, and overall satisfaction dysfunction were noted following treatment., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background and Aims: Therapeutic possibilities now exist to lower low-density lipoprotein cholesterol (LDL-C) to very low levels. However, substantial controversy remains in clinical practice with regard to its safety, and the question of whether low LDL-C levels per se may provoke adverse effects in humans arises. We aimed to explore the association of LDL-C with androgen and erectile dysfunction (ED) in a general population of men., Methods and Results: A total of 4203 men without hormone replacement therapy were enrolled from 22 sites in East China. Total testosterone (T) and Free T were assessed. Free androgen index (FAI) was calculated. The IIEF-5 questionnaire was used to assess ED. We found that free T and FAI gradually and markedly increased with increasing LDL-C levels. Using linear regression, after adjusting for age, educational level, economic status, smoking status, drinking status, BMI, diabetes, and use of lipid-lowering medication, LDL-C was positively associated with free T (B = 0.175, 95% CI: 0.084, 0.266) and FAI (B = 0.064, 95% CI: 0.016, 0.112). Meanwhile, there was a U-shaped curvilinear relationship between LDL-C and prevalence of ED. In the logistic regression analysis, compared to those with LDL-C among the 10th-90th percentile, the ORs of ED in men in the lowest and highest deciles were 1.938 (95% CI: 1.121, 3.349) and 1.804 (95% CI: 1.117, 2.916), respectively., Conclusion: Lower LDL-C levels were significantly associated with lower free T and lower FAI in a general population of men. Moreover, both low and high levels of LDL-C might be risk factors for ED., (Copyright © 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

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.

Introduction: This study explores the relationship between erectile function and ejaculatory function, to inform the clinical psychosexological and sexual medicine practice treatment protocols., Materials and Methods: A total of 1,004 Czech males aged between 15 and 84 years (m = 42.8 yrs; sd = 17.6 years) completed a sexual behavior questionnaire. A cross-sectional design was adopted. Erectile function was measured with the International Index of Erectile Function (IIEF-5) and ejaculatory function measured using self-report intravaginal ejaculation latency time and the Index of Premature Ejaculation (IPE). Linear regression analyses were used to explore the relationships between premature ejaculation and erectile dysfunction., Results: The sample mean self-reported intravaginal ejaculatory latency time was 9.34 minutes. The overall mean on the IPE was 19.44 (sd = 2.368). The Control domain mean was 81.13 (sd = 17.22); Sexual Satisfaction domain mean 78.60 (sd = 20.59); and the Distress domain mean was 86.86 (sd = 18.32). The mean score on the IIEF-5 was 19.28 (sd = 2.53). The results indicate a relationship between premature ejaculation and erectile dysfunction. With age significantly associated with all measures., Conclusions: Higher levels of erectile function are associated with a better control and sexual satisfaction, and less distress about ejaculation. This association supports the consideration of this relationship in the development of new clinical practice guidelines for erectile dysfunction and premature ejaculation., Competing Interests: The authors have declared that no competing interests exist.

Background: Sexual dysfunction affects millions of people with an increasing prevalence, worldwide. The pathophysiology of the disease shares several similarities with cardiovascular disease (CVD), including atherosclerosis, endothelial dysfunction, structural vascular damage and subclinical inflammation. Erectile dysfunction (ED) and female sexual dysfunction are common among patients with CVD and risk factors such as hypertension, diabetes, obesity and metabolic syndrome. Given the common pathogenesis of the diseases, ED is an independent prognostic factor of future ED events. Patients with overt ED or risk factors are usually treated with several drugs for the management of these conditions. Several of these drugs have been evaluated for their effect on sexual activity., Results and Conclusion: Among the antihypertensive drugs, diuretics and beta-blockers seem to exert a detrimental impact on sexual function, with nebivolol being the only beta-blocker with favorable properties through an increase in nitric oxide bioavailability. In contrast, renin-angiotensin system inhibitors and calcium-channel blockers have a neutral effect on sexual activity. Hypoglycemic drugs have been less evaluated in the ED setting, with metformin, pioglitazone and liraglutide presenting favorable results. Statins on the other hand have not provided consistent results with observational studies suggesting a detrimental role in sexual activity and a few randomized studies indicating a neutral or even beneficial effect on erectile function., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Objectives: To evaluate the frequency of sexual dysfunction and associated factors in patients with central serous chorioretinopathy (CSCR)., Material and Methods: Fifty-eight CSCR patients who met the inclusion criteria and 99 age- and sex-matched healthy controls were prospectively investigated for sexual dysfunction and associated factors. All participants were investigated using the Beck Depression Inventory (BDI), Beck Anxiety Scale (BAS), and the15-question Index of Erectile Function-15 (IIEF-15) and by extensive examination of CSCR, associated factors, and confounding factors., Results: The mean ages of the patient and control groups were 46.95±11.27 and 45.3±10.93 years, respectively (p=0.370). The erectile function, orgasmic function, sexual desire, sexual satisfaction, and overall sexual satisfaction scores of the patient group were significantly lower than those of the control group (p<0.001). Severe erectile dysfunction (ED) was diagnosed in 3 (5.2%), moderate ED in 10 (17.2%), mild-to-moderate ED in 7 (12.1%), and mild ED in 15 (25.9%) patients in the patient group, whereas no severe or moderate ED was diagnosed in the control group. The erectile function score was found to be negatively correlated with age and BMI. No sexual parameters were found to be correlated with choroidal thickness (CT) in either the patient or control group., Conclusion: CSCR patients experience a higher incidence of sexual dysfunction compared to healthy individuals without CSCR. The exclusion of confounding factors suggests that factors involved in CSCR pathogenesis may also play a role in ED.

Introduction: Penile carcinoma is one of the less frequent tumors of the genitourinary system, however its effect on the patients' sex life and quality of life is of great impact. Studies about the influence on patients' sex life are scarce., Objectives: To characterize sexual activity with penetration of patients with penile carcinoma who underwent different conservative therapeutic approaches and to evaluate pre and post treatment erectile function. Secondarily, to compare the results between the patients who underwent partial penectomy to those subjected to other conservative therapies., Material and Methods: Review of patients' records diagnosed with penile carcinoma and observed at the Portuguese Institute of Oncology of Oporto between 2005 and 2015, to obtain demographic, clinical and histopathological data. Telephone interviews for the completion of the International Index of Erectile Function-5 (IIEF-5) questionnaire to patients undergoing treatment in that period., Results: 16 out of the 107 patients met the inclusion criteria (n=16), with an average IIEF-5 score of 23.44 (10-25), lowering this value to 16.56 (5-25) after therapy, p<0,05. Fifteen out of the 16 patients kept sexual activity (93.8%) and one (6.25%) suspended due to erectile dysfunction. IIEF-5 score after treatment in the subgroup that underwent partial penectomy was lower when compared to the other subgroup of patients subjected to others conservative therapies, without statistical significance., Conclusion: Although penile carcinoma treatment has an impact in erectile function with statistical significance, the majority of patients keeps an active sexual life with penetration after treatment. It's not possible to conclude that less invasive therapies are associated with better erectile function., (Copyright © 2017 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

To estimate the prevalence of erectile dysfunction (ED) and the level of psychological distress and to assess the inter-associations of them among type 2 diabetic men, a cross-sectional observational study of 335 men with type 2 diabetes and 284 men without diabetes from a hospital in Hefei city, Anhui province, China, was conducted. The erectile function was assessed using the five-item version of the International Index of Erectile Function scale (IIEF-5). The evaluation of psychological distress was completed using a self-administered questionnaire, the Symptom Checklist 90-Revised (SCL-90-R). In this study, ED was more prevalent in type 2 diabetic men than that in the control group (58.51% vs 26.76%, P<0.001). All subscale scores of SCL-90-R were significantly higher in the group with type 2 diabetes (N=335) than those in the group without type 2 diabetes (N=284). All scores of SCL-90-R subscales were inversely correlated with IIEF-5 score. ED and psychological distress were strongly correlated in type 2 diabetic patients. Clinicians should be aware of the association between ED and psychological distress when treating men with type 2 diabetes.

Erectile dysfunction (ED) is a common male disease. Some related studies show that the prevalence of ED is nearly 52% in men aged 40 to 70 years and is increasing among younger males. Hypoxia is now considered to be an independent risk factor for ED and the mechanisms of hypoxia inducing ED are varied and complicated. Recently, an idea in penile rehabilitation has attracted much attention, which aims at improving erectile function by increasing oxygen supply to the cavernosum and reducing tissue fibrosis and apoptosis. The approaches to achieve non-sexual penile erection by increasing oxygen supply to the cavernosum, such as behavior therapy, medication, vacuum constriction device, and intracavernous injection, can simulate normal sexual erection and help patients with penile rehabilitation. This review focuses on the strategies for non-sexual penile erection in penile rehabilitation.

Erectile dysfunction (ED) is one of the most common disorders in male and is often associated with other age-related comorbidities. The aging process affects the structural organization and function of penile erectile components such as smooth muscle cell and vascular architecture. These modifications affect penile hemodynamics by impairing cavernosal smooth muscle cell relaxation, reducing penile elasticity, compliance and promoting fibrosis. This review aims to identify the mechanisms of ED in the penile aging process in experimental and clinical data. It also highlights areas that are in need of more research. The search strategies yielded total records screened from PubMed. Clarification of the molecular mechanisms that accompanies corpus cavernosum aging and aging-associated ED will aid new perspectives in the development of novel mechanism-based therapeutic approaches. Age is not a limiting factor for ED medical management, and it is never too late to treat. Hypogonadism should be managed regardless of age, and synergistic effects have been found during testosterone (T) replacement therapy when used along with oral phosphodiesterase-5 (PDE-5) inhibitors. Therefore, the clinical management of ED related to aging can be done by therapeutic interventions that include PDE-5 inhibitors, and other pharmacological treatments.

Only limited epidemiological evidence exists regarding the relationship between diabetic neuropathy and erectile dysfunction (ED) among Japanese patients with type 2 diabetes mellitus. To investigate the relationship between diabetic neuropathy and ED among Japanese patients with type 2 diabetes mellitus, a multicenter cross-sectional study was conducted in 287 male Japanese patients with type 2 diabetes mellitus, age (19-65 years). Diabetic neuropathy was diagnosed if the patients showed two or more of the following three characteristics: neuropathic symptoms, decreased or disappeared Achilles tendon reflex and/or abnormal vibration perception. ED, moderate to severe ED, and severe ED were defined as present when a subject had a Sexual Health Inventory for Men score <22, <12 and <8, respectively. The prevalence values of diabetic neuropathy and severe ED were 47.0 and 39.0%, respectively. Diabetic neuropathy was independently positively associated with severe ED, but not ED and moderate ED: the adjusted odds ratio was 1.90 (95% confidence interval: 1.08-3.38). No relationships were found between diabetic retinopathy or diabetic nephropathy and ED. Diabetic neuropathy is positively associated with severe erectile dysfunction among Japanese type 2 diabetes mellitus patients aged <65 years.

Background: Erectile dysfunction (ED) is a predictor or marker of coronary artery disease in patients at high risk of cardiovascular diseases. The aim of this study was to investigate the prevalence of ED in patients with acute myocardial infarction (AMI) and after 2 years of follow-up, and to determine the association between ED and the concentrations of the markers of inflammation, endothelial dysfunction and oxidative stress which were measured on the third day after hospital admission., Methods: The study included 80 patients aged 62.25 ± 10.47 years. The primary endpoints of interest were re-hospitalization due to cardiovascular causes and death during the 2 year period after hospital-ization. The Sexual Health Inventory for Men (SHIM) was assessed at the point of hospital discharge and 24 months thereafter., Results: 40.1% of patients had some degree of ED. The percentage of patients without ED increased (13.2%), while the percentage of patients with severe ED significantly decreased (14.7%) after 2 years. Patients with ED had significantly higher B-type natriuretic peptide (BNP) levels and decreased levels of nitric-oxide. During the 2 years of follow-up, 9 patients died (6.5% without ED, 68.6% with ED) (c2 = 7.19, p = 0.015). During the same time period, 22 (27.5%) patients were re-hospitalized due to cardiovascular causes, of whom 59.1% had ED at hospital admission (p < 0.05)., Conclusions: Low levels of nitric-oxide were the best predictors of ED during AMI and after 2 years. ED predicted the worst outcomes of AMI: death and re-hospitalization. Lifestyle changes and nitric- -oxide donors could assist in the treatment of ED and in the improvement of long-term prognosis for AMI. (Cardiol J 2017; 24, 4: 393-402).

Background: Published clinical practice guidelines have addressed antihypertensive therapy and sexual dysfunction (SD) in many different ways., Objective: In this systematic review, we evaluated guidelines that address antihypertensive drug-associated SD, guideline recommendations, and recent guideline trends., Methods: Thirty sets of guidelines for hypertension management in adults that had been published in the English language since 2000 were reviewed. The primary outcome measure was antihypertensive-associated SD potential, which was independently evaluated using specific questions by 2 authors in a nonblinded standardized manner., Results: Sexual dysfunctions associated with thiazide-class diuretics, β-blockers, and centrally acting sympathoplegics were addressed by half of the guidelines reviewed. There is no clarity on β-blockers and thiazide-class diuretics because one-third of the guidelines are vague about individual β-blockers and diuretics, and there is no statement on third-generation β-blockers and thiazide-like diuretics that can improve erectile function. The revised guidelines never use terms such as loss of libido, ejaculatory dysfunction, lack of orgasm, and priapism. Summary versions of guidelines are inadequate to reflect the key interpretation of the primary guidelines on SD associated with antihypertensives, even in the major guidelines that were updated recently. Therapeutic issues such as exploring SD in clinical history, assessing SD prior to and during treatment with antihypertensives, substituting the offending agents with alternatives that possess a better safety profile, intervening with phosphodiesterase-5 inhibitors, and avoiding the concomitant use of nitrovasodilators are superficially addressed by most guidelines, with the exception of 2013 European Society of Hypertension/European Society of Cardiology and Seventh Joint National Committee recommendations., Conclusion: Future guideline revisions, including both full and summary reports, should provide a balanced perspective on antihypertensive-related SD issues to improve the impact of hypertension treatment guidelines on patient care and quality of life., (© The Author(s) 2015.)

Erectile dysfunction (ED) is a common complication of diabetes, affecting up to 75% of all diabetic men. Although the aetiology of diabetic ED is multifactorial, endothelial dysfunction is recognized as a mainstay in the pathophysiology of the disease. Endothelial dysfunction is induced by the detrimental actions of high glucose levels and increased oxidative stress on endothelial cells that make up the vascular lining. Besides directly injuring the endothelium, diabetes might also hamper vascular repair mechanisms of angiogenesis and vasculogenesis. These states exacerbate and maintain endothelial dysfunction, impairing vasorelaxation events and cavernosal blood perfusion, which are crucial for normal erectile function.

Materials and Methods: The study was conducted from December 2011 to December 2012 on 95 patients between the ages of 20 and 65 years: 44 of which had been undergoing dialysis for over a year and 51 of whom had undergone kidney transplants more than 6 months before. Comorbidities were carefully recorded, erectile function was evaluated the with IIEF5 questionnaire and serum levels of total testosterone / free and prolactin were tested at early morning (7 AM). To assess the relationship between erectile dysfunction (ED) and clinical laboratory tests, Student's t-test statistical (quantitative variables), chi-square (qualitative variables), the uni and multivariate analysis were used., Results: In patients undergoing dialysis and in recently transplanted patients a higher instance of ED was found (70% and 65% of cases respectively). Amongst dialyzed patients, patients aged over 50 suffer from ED more frequently. Patients aged over 50s represent 61% of the total number of patients suffering from ED, and just 31% of patients not suffering from ED, (p = 0.006); Hyperprolactinemia was found in 23% and 20% of both groups respectively. Fifty nine % of the dialyzed patients presented values of testosterone serum levels of less than 250 ng/dl with a significant difference between those who were suffering from ED and those who were not (65% of ED patients vs. 46%,of patients not affected from ED p = 0.019). This was found in only 37% of transplanted patients and there does not appear to be a statistically significant correlation with the onset of ED (p = 0.12). In patients over the age of 50, diabetes and a condition of hypotestosteronemia were significantly correlated with ED at univariate and multivariate analyses., Conclusions: The ED in patients with end stage chronic kidney failure (CKF) continues to have a strong prevalence, either in the patients who are undergoing dialysis or in those who have received transplants. In literature this issue is not sufficiently considered if not at all. Hypotestosteronemia is a risk factor for the onset of ED in end stage CKF patients. A significantly lower prevalence of hypogonadism among dialyzed patents and transplant recipients suggests that renal transplantation may be protective for the sexual capabilities of these patients.

Erectile dysfunction is a common condition in aging men and significantly affects their quality of life and interpersonal relationships. Its prevalence and incidence are associated with aging, lifestyle factors and cardiovascular comorbidities. Preoccupation with male virility has been present for centuries, and a wide variety of herbs and potions have been used to treat any sexual deficiencies. Recent major advances in understanding of erectile physiology and pathophysiology led to development of currently available systemic and local pharmacotherapies. They are designed to work either centrally or peripherally and to either suppress anti-erectile mechanisms, enhance the pro-erectile ones or influence both. Since all the current formulations have variable safety and efficacy profiles, the search for highly specific, simple, convenient and clinically effective impotence treatments or prophylactics continues., (© 2015 American Society for Clinical Pharmacology and Therapeutics.)

Purpose: The aim of this study was to investigate the connection between erectile dysfunction (ED) and cardiovascular diseases and to test a novel visual-scale questionnaire (VEF) we propose for the assessment of erectile function., Subjects and Methods: Erectile function was assessed in 170 male cardiovascular patients under the age of 70 by the use of several self-administered questionnaires: the International Index of Erectile Function-5 (IIEF-5); the Massachusetts Male Aging Study questionnaires (MMAS Sexual Activity Questionnaire and MMAS Single Question), and finally, VEF., Results: Patients’ mean age was 55.65 ± 9.97 y. The most common indications for hospitalization were coronary artery disease (CAD) (n = 82, 48%), and decompensated chronic heart failure (n = 30, 18%). The prevalence of ED as determined by IIEF-5 was 58% (n = 99). Patients with ED were on average 5.7 years older (P = 0.0001), had a higher frequency of diabetes (by 19%, P < 0.01), and a somewhat higher level of uric acid (by 72 μmol/l, P < 0.01). Results of the VEF correlated significantly with those of other questionnaires. Three different machine learning algorithms demonstrated a greater accuracy of VEF than IIEF-5 and MMAS Sexual Activity Questionnaire in predicting ED severity., Conclusion: ED is highly prevalent among cardiovascular patients. The Visual Scale Erectile Function questionnaire (VEF) is a simple and valid tool, suitable for quick screening of this condition.

Introduction: Much of the research on the association between erectile dysfunction (ED) and possible clinical relevant hypersexuality up to now has been only descriptive in nature., Aim: The present study aimed to explore the relationships among hypersexuality, ED, and sexual boredom in a sample of coupled community men., Methods: An Internet-based survey was conducted in two European countries. The sample included 911 Croatian and 210 German coupled men. The survey comprised the Hypersexual Disorder Screening Inventory, the International Index of Erectile Function and the Sexual Boredom Scale. Poisson regression analysis was used to examine how ED, solitary sexual activities and sexual boredom were associated with hypersexuality., Results: Among Croatian and German men, hypersexuality was significantly correlated with proneness to sexual boredom and more problems with erectile function., Conclusions: In some men, hypersexual behavior may serve as a coping mechanism for sexual fantasy poverty-associated boredom. In addition, ED within an intimate relationship can accompany this simultaneously., (© 2015 International Society for Sexual Medicine.)

Introduction: Erectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties., Aims: This study aimed to identify independent predictor factors for ED in patients with epilepsy., Main Outcome Measures: the five-question form of the International Index of Erectile Function (IIEF-5)., Methods: Independent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis., Results: Eight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B=0.005; p=0.05), education levels in years (B=0.54; p=0.03), depressive symptoms determined by HADS depression subscale (B=-0.49; p=0.03), and prolactin levels (B=-0.45; p=0.07) showed a moderate association (r=0.64) with the IIEF questionnaire and explained 41% (r(2)=0.41) of its variation., Conclusions: Erectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Erectile dysfunction (ED) is highly prevalent in patients with diseases of cardiovascular system, including patients with atrial fibrillation (AF). Reasons for this high co-prevalence include endothelial dysfunction, inflammation, oxidative and emotional stress associated with AF. Association of AF-induced prothrombotic state and possible microthrombi in penile arteries with ED remains unclear. The present study aims to assess if probability of AF-associated risk of peripheral thromboembolism may be associated with ED in AF patients., Methods: Probability of thromboembolic complications was assessed with two commonly used risk scores CHADS₂ and CHA2DS₂-VASc in a group of continuous AF patients. All patients were also asked to fill an IIEF-5 questionnaire designed for screening for ED., Results: Mean CHADS₂ score in the whole study group was 1.1 ± 1.0 points and CHA₂DS₂- -VASc was 1.5 ± 1.4 points. ED was present in 57.4% of the 129-person study population. In patients with ED, both CHADS₂ (0.9 ± 1.0 vs. 1.3 ± 1.1; p = 0.03) and CHA₂DS₂-VASc (1.2 ± 1.1 vs. 1.8 ± 1.5; p = 0.03) scores were significantly higher than in the group without dysfunction. After dividing the patients according to age into groups younger than 65 years vs. ≥ 65 years, observed correlation was no longer significant in the younger group (p > 0.05). In patients ≥ 65 years, in whom the risk scores are routinely used, dysfunction both CHADS₂ (1.1 ± 0.9 vs. 2.0 ± 0.9; p = 0.02) and CHA₂DS₂-VASc (2.3 ± 1.1 vs. 3.4 ± 1.3; p = 0.04) scores were higher in the group with ED., Conclusions: Erectile dysfunctions in AF patients are associated with elevated cardioembolic risk. We postulate that the diagnosis of ED should be considered an additional marker of prothrombotic state, and may be useful in clinical decision-making, especially in patients ≥ 65 years old.

Objective: To evaluate whether hormonal markers predict erectile dysfunction (ED) and symptoms of T deficiency syndrome (TDS), which are commonly found in the population of infertile men., Design: Retrospective study utilizing a prospectively maintained infertility database., Setting: A tertiary referral center., Patient(s): A total of 1,750 of 2,783 men presenting for evaluation of infertility between 1995 and 2010 completed validated questionnaires., Intervention(s): Androgen Deficiency in the Aging Male (ADAM) and Sexual Health Inventory for Men questionnaires were administered. Baseline risk factors for ED and TDS were also measured. Subjects underwent serum hormone evaluation for total T, calculated bioavailable T, sex hormone-binding globulin, E2, LH, FSH, and PRL., Main Outcome Measure(s): Multivariable logistic regression modeling was used to determine the significance of hormonal markers in predicting ED (Sexual Health Inventory for Men score <22) and/or a positive ADAM score., Result(s): The prevalence of ED and a positive response to the ADAM questionnaire were 30.5% and 45.2%, respectively, in this population (mean age, 36 years). Low serum T (total T < 10 nmol/L) was found in 29.4%. Neither T nor bioavailable T was significantly associated with the symptoms of ED or TDS on multivariable regression analysis., Conclusion(s): Erectile dysfunction and TDS in young, infertile men seem to be unrelated to hormone changes., (Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

This study aimed to examine the psychometric values of a Farsi-translated version of the International Index of Erectile Function among a population sample of Iranian men. A community sample of 2,345 healthy men and a clinical sample of 421 men with diagnosed erectile function from 2 cities of Iran participated in the study. Participants were asked to complete the International Index of Erectile Function, the Life Satisfaction questionnaire, and a demographic questionnaire at baseline. Four weeks later, both samples were asked to recomplete the International Index of Erectile Function. The response rates were 84% (n = 1,969) and 98% (n = 412) for healthy men and men with erectile function, respectively. The retest reliability of the International Index of Erectile Function showed excellent intraclass correlation coefficients for both the healthy and patient samples. The International Index of Erectile Function subscales correlated significantly with the scores resulting from the clinical rating of erectile function conducted by urologists. Men with erectile function, as diagnosed by urologists, had significant lower scores in all subscales. The results of the exploratory factor analysis indicated that the International Index of Erectile Function could be summarized into a 5-component solution.The Iranian version of the International Index of Erectile Function was found to be a highly valid and reliable instrument to be used for the assessment of erectile function in clinical and population samples.

Introduction and Aim: This article reviews the current literature on common physiopathogenetic factors and pharmacological pathways of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men and their implications for diagnosis and treatment., Main Outcome Measures and Methods: A literature search was conducted to identify original articles, reviews, editorials, and international scientific congress abstracts by combining the following terms: lower urinary tract symptoms, erectile dysfunction and phosphodiesterase type 5 inhibitors (and their abbreviations LUTS, ED and PDE5-Is)., Results: We identified manuscripts presenting: (i) The existence of several newly discovered common pathophysiological mechanisms of LUTS and ED indicating that PDE5-Is might represent an alternative to current treatments of men with LUTS (e.g., α1-adrenergic blockers and 5α-reductase inhibitors); (ii) Randomized controlled clinical trials have shown that treatment with PDE5-Is is associated with improvements in both LUTS and ED in men with significant problems in both areas., Conclusion: The presence of common pathophysiological mechanisms between LUTS and ED seems well recognized and needs further exploration. Further comparisons between different PDE5-Is would be useful to determine the most appropriate regimen and their efficacy to safety ratio., (© 2013 International Society for Sexual Medicine.)

Introduction: Erectile dysfunction (ED) incidence following repeat saturation prostate biopsy (SPBx) was evaluated., Materials and Methods: From January 2011 to June 2012 295 patients underwent repeat transperineal SPBx (median 28 cores) under sedation. The indications for biopsy were: abnormal DRE, PSA > 10 ng/mL or included between 4.1-10 with free/total PSA < 25%. All patients were prospectively evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5) at baseline and 1, 3 and 6 months from SPBx., Results: 100/200 men with benign histology and normal sexual activity completed the study; median IIEF-5 score before and after SPBx was equal to 18.3 (baseline) vs 17.8 (1 month later) vs 18 (3 months later) vs 18.1 (6 months later) (p > 0.05); in detail, 1 month from biopsy 5 (5%) men referred a mild ED that disappeared at 3 and 6 months evaluation., Conclusions: Repeat transperineal SPBx under sedation did not significantly worsened erectile function; the minimal risk of temporary post-biopsy ED could be previously discussed (not emphasised) with potent patients.

Objectives: No investigation in mainland China concerning erectile function in men with liver transplant for benign end-stage liver disease has been performed., Materials and Methods: Sixty men with a liver transplant for benign end-stage liver disease (post-liver transplant group) between October 2003 and December 2008 were invited to evaluate erectile dysfunction with the Chinese version of the 5-item international index of erectile function. Fifty-seven patients with benign end-stage liver disease (pre-liver transplant group) on the waiting list also were investigated., Results: The proportion of sexually active patients in the post-liver transplant group was higher than it was in the pre-liver transplant group (80% [48/60] vs 47.7% [21/44]; P < .01). The mean International Index of Erectile Function-5 score of responders was significantly higher in the post-liver transplant group than it was in the pre-liver transplant group (15.9 ± 8.5 vs 8.5 ± 9.1; P < .01). The incidences of no erectile dysfunction, mild, mild-moderate, moderate, and severe erectile dysfunction and total erectile dysfunction were 15.9% (7/44), 9.1% (4/44), 15.9% (7/44), 0% (0/44), 59.1% (26/44), and 84.1% (37/44) in the pre-liver transplant group, and 33.3% (20/60), 20% (12/60), 25% (15/60), 0 (0/60), 21.7% (13/60), and 66.7% (40/60) in the post-liver transplant group. The pre-liver transplant group had higher incidence of severe erectile dysfunction and total erectile dysfunction and a lower incidence of no erectile dysfunction than did the post-liver transplant group (P < .05). There was a comparable incidence of mild and mild-moderate erectile dysfunction with the post-liver transplant group (P > .05). Variables associated with International Index of Erectile Function-5 score of the post-liver transplant patients included age, profession, and immunosuppressive protocol., Conclusions: Liver transplant may improve erectile function in persons with benign end-stage liver disease, but erectile dysfunction remains a problem in the post-liver transplant patients.

Retrograde ejaculation (RE) and erectile dysfunction may be caused by diabetes mellitus (DM), but the prevalence of RE among DM patients is unknown. A prospective, blinded case-control study comparing men with DM with matched controls according to RE and erectile dysfunction was performed. Twenty-seven men with DM matched the inclusion criteria and agreed to participate in the study, and of these 26 delivered an ejaculate. We were able to recruit 18 matching controls, and of these 16 delivered an ejaculate. Nine of 26 men with DM who delivered an ejaculate had RE, whereas none of 16 controls had RE (p < 0.01). The mean duration of DM was longer for DM patients with RE (20 years) compared with DM patients in whom RE could not be demonstrated (13 years), but the difference was not statistically significant. RE could not be associated with BMI, waist circumference, blood pressure, Haemoglobin A1c (HgbA1c), high-density lipoprotein HDL cholesterol, triglycerides, fasting glucose, or s-testosterone. Diabetics suffering from RE more frequently exhibited erectile dysfunction compared with non-diabetics and diabetics without RE, and the last-mentioned group again more frequently than controls. These findings could not be explained by use of antihypertensive drugs. Whereas none of the included control participants showed signs of abnormal ejaculation, every third man with DM exhibited retrograde ejaculation. It is important to be aware of this association, and that post-ejaculatory urine is routinely analysed from aspermic fertility clinic attendants and diabetics with low ejaculate volumes., (© 2013 American Society of Andrology and European Academy of Andrology.)

Objective: To investigate the treatment effect on penile erectile function after lumbar discectomy in different age groups of men., Methods: We included in this study 90 male patients with intervertebral disc herniation treated by lumbar discectomy, who were divided into three age groups of equal number: groups A (< 45 yr), B (45 - 55 yr) and C ( > 55 yr). We obtained the IIEF-5 scores of the patients preoperatively and at 12 months after surgery., Results: The IIEF-5 scores at 12 months after surgery were 21.3 +/- 3.3, 16.8 +/- 1.3 and 14.1 +/- 1.0 in groups A, B and C, respectively, significantly higher than 10.4 +/- 2.6, 10.7 +/- 2.8 and 11.2 +/- 1.9 preoperatively (P < 0.05). Group A showed better improved erectile function than B and C ([51.17 +/- 6.25 ]% vs [36.31 +/- 4.28]% and [22.71 +/- 5.68]%, P < 0.05)., Conclusion: Penile erectile function of the male patient is one of the major factors in evaluating lumbar discectomy for intervertebral disc herniation. Early decompression surgery according to different etiological factors is very important for erectile function recovery in the young and middle-aged male patients.

Objective: To learn the incidence of erectile dysfunction (ED) after pelvic fracture urethral injury (PFUI) and to identify the related risk factors., Methods: Patients who had sustained a PFUI from 1984 to 2010 were identified from database and invited to participate in the study. All responders were queried after a minimum of 2 years from the time of trauma to assess their erectile function (EF) using the EF domain of the International Index of Erectile Function (IIEF). Medical records and imaging studies were reviewed with a focus on 6 variables that may predict ED. Univariate and multivariate analyses were used to identify parameters predictive of ED., Results: Overall, 90 patients participated in the study, among whom 40 (44%) had ED. On univariate analysis, 4 variables were significant factors for prediction of ED, whereas on multivariate analysis only 3 factors remained strong and independent predictors, namely diastasis of pubic symphysis, lateral displacement of prostate, and long urethral gap. The results of analyses showed that these 3 variables were significant at odds ratios (ORs) of 15.9, 6.9, and 2.0, respectively., Conclusion: The development of ED after PFUI can be predicted by 3 factors, namely diastasis of pubic symphysis, lateral prostatic displacement, and long urethral gap. Pubic diastasis has the highest predictive accuracy. A tendency for higher risk of ED could be observed after bilateral rami and Malgaigne's fractures, but they failed to reach the level of significant predictors on multivariate analysis. No relationship was evidenced between ED and age at traumatism., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Introduction: Treatment with 5-alpha reductase inhibitors (5ARI) is commonly utilized for the treatment of benign prostatic hyperplasia (BPH). The true prevalence of sexual side effects with 5ARI treatment is currently unknown., Areas Covered: The current article reviews the reported adverse effects of 5ARI in regard to erectile function, sexual desire and ejaculation. A PubMed search was performed of all articles from 1990 to present, which reported any sexual side effects with finasteride or dutasteride. Preference was given to more recent and human studies where available., Expert Opinion: Clinical trials with 5ARI report prevalence rates of de novo erectile dysfunction of 5 - 9%. Decreased circulating dihydrotestosterone (DHT) resulting from 5ARI use is associated with diminished sexual desire and/or orgasm. The presence of adverse sexual effects is associated with decreased self-esteem, quality of life and ability to maintain an intimate relationship. Inhibition of 5ARI additionally influences progesterone and deoxycorticosterone levels and may alter psychological functions, including increased depression, melancholy and loss of general well being. Ejaculatory dysfunction has not been well studied in patients using 5ARI. Patients receiving therapy with 5ARI should be counseled as to potential sexual and psychological adverse effects. Future clinical studies are needed to further investigate the sexual side effects associated with this class of drugs.

Objectives: To examine the association between body size and composition and erectile dysfunction (ED) in older men., Design: Cross-sectional analysis of the Osteoporotic Fractures in Men study., Setting: Six U.S. clinical sites., Participants: Community-dwelling men aged 65 and older., Measurements: Body composition measures using anthropometry (body weight, body mass index (BMI)) and dual X-ray absorptiometry (total body fat percentage, trunk fat percentage, ratio of trunk and total body fat). ED was assessed using the single-item Massachusetts Male Aging Study (MMAS) scale and the five-item International Index of Erectile Function questionnaire (IIEF-5)., Results: In men completing the MMAS scale (n = 4,108), prevalence of complete ED was 42%. In sexually active men completing the IIEF-5 questionnaire (n = 1,659), prevalence of moderate to severe ED was 56%. In multivariate-adjusted analyses reporting prevalence ratios (PRs) and 95% confidence intervals (CIs), the prevalence of MMAS-defined complete ED was significantly greater in men in the highest quartile of body weight (PR = 1.24, 95% CI = 1.16-1.34), total body fat percentage (PR = 1.25, 95% CI = 1.13-1.40), and trunk fat percentage (PR = 1.24, 95% CI = 1.15-1.38), and was greater in men with a BMI greater than 30.0 kg/m(2) than in those with BMI of 22.0 to 24.9 kg/m(2) (PR = 1.17, 95% CI = 1.05-1.31). Associations appeared similar for IIEF-5-defined moderate to severe ED in analyses adjusted for age and study site., Conclusion: In a cohort of older men, high body weight, BMI, and total body fat percentage were independently associated with greater prevalence of moderate to severe and complete ED. Future studies should investigate whether interventions to promote weight loss and fat loss will improve erectile function in older men., (© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.)