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There are currently no studies exploring omicron infection and male sexual function and semen quality. Our aim was to estimate changes in sexual function and semen quality in men recovering from infection since the COVID-19 Omicron pandemic started in China in late 2022. We collected 1540 questionnaires and assessed male function before infection and acute phase after infection by using International Index of Erectile Function-5, Premature Ejaculation Diagnostic Tool, and Arizona Sexual Experience Scale. We also collected the before and after semen analysis results of 247 male patients. During the acute phase after infection, the proportion of erectile dysfunction was significantly higher than before infection, but ejaculatory function was not significantly altered; In addition, semen analysis showed significant difference in semen concentration, semen activity and PR a+b sperm forward movement after infection compared to pre-infection.: COVID-19 Omicron can affect erectile function as well as sexual experience in male patients in the acute phase. Decreased sexual function due to COVID-19 Omicron may be related to body temperature and anxiety during infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xiao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We aimed to establish the prevalence of atypical masturbation in the general population and explore the association between atypical masturbation and male sexual dysfunction in heterosexual males. Atypical masturbation refers to stimulation significantly distinct from that encountered during partnered sexual activity. We posted questionnaires that contained the abridged International Index of Erectile Function (IIEF-6) and the premature ejaculation diagnostic tool on social media in China. We collected 2743 valid questionnaires from December 9, 2020, to April 18, 2021. We found that the prevalence of atypical masturbation in the general population was 10.97%. Men with atypical masturbation had lower IIEF-6 scores and higher rates of erectile dysfunction (ED) than men with typical masturbation. The prevalence of premature ejaculation and estimated intravaginal ejaculatory latency time were not significantly different among men with different patterns of masturbation. Our study demonstrated that atypical masturbation is associated with ED, and a clinician dealing with sexual issues should inquire more fully about masturbation patterns than has been done to date., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Sexual dysfunction is common in males with chronic kidney disease (CKD), but yet the prevalence and specific relationship between CKD and sexual dysfunction, especially premature ejaculation (PE), remain to be investigated in China; This study aims to examine the prevalence and association between CKD and sexual dysfunction in male patients in China; In this cross-sectional, non-interventional, observational study conducted at a single center. 72 male patients with CKD were enrolled. Data collection included socio-demographic information, assessments via the 5-item version of the International Index of Erectile Function (IIEF-5), the Chinese version of the Premature Ejaculation Diagnostic Tool, the Patient Health Quentionnnaire-9 and the General Anxiety Disorder-7. Data analysis was performed using R version 3.5.2 and SPSS software version 25.0; Among the 72 CKD patients, 56.9% experienced erectile dysfunction and 29.2% had PE. Various factors including estimated Glomerular Filtration Rate, Albumin-to-Creatinine Ratio, psychological aspects, medication use were found to be associated with sexual dysfunction in these CKD patients; Sexual dysfunction is prevalent in males with CKD and is, influenced by multiple factors. It is important for clinicians to focus on sexual dysfunction in this patient group and further investigate its underlying mechanisms., (© 2024. The Author(s).)

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in adult men. Evidence has demonstrated that acupuncture is effective for treating CP/CPPS. Electroacupuncture (EA) is a combination of traditional acupuncture and electrical stimulation, and the waveform is one of the key factors influencing EA effects. Different waveforms contain different stimulating parameters, thus generating different effects. However, the effects of different waveforms of EA on CP/CPPS remain unclear and there is no recommended standard for the application of EA waveforms. At the same time, the waveform prescription of CP/CPPS is also different, so exploring the influence of different waveforms on CP/CPPS patients will also provide a certain treatment basis for clinical treatment. A total of 108 eligible patients were recruited from the Seventh People's Hospital affiliated to the Shanghai University of Traditional Chinese Medicine from March 18, 2021, to January 31, 2022, according to inclusion and exclusion criteria. All subjects were randomly divided into three groups (continuous wave 4 Hz, continuous wave 20 Hz, and extended wave 4/20 Hz) in a ratio of 1 : 1 : 1. Patients in all three groups were treated for the same duration of 20 minutes, with intervention twice a week for 4 weeks. The changes in chronic prostatitis index (NIH-CPSI), erectile function index 5 (IIEF-5), Hospital Anxiety and Depression Scale (HADS), and NIH-CPSI response rate in three groups were compared after the intervention, and the occurrence of adverse events in patients during treatment was observed. After 4 weeks of treatment, the CP/CPPS response rates were 66.7%, 62.5%, and 88.2% in the 4 Hz, 20 Hz, and 4/20 Hz groups, respectively. The reaction rate of CP / CPPS in 4 / 20 Hz group was higher than that in 4 Hz group and 20 Hz group. ( P < 0.05). During treatment, the difference between NIH-CPSI scores between 4 Hz and 4/20 Hz was insignificant ( P > 0.05). NIH-CPSI scores were lower in the 4/20 Hz group than in the 4 Hz and 20 Hz groups ( P < 0.05). After treatment, there was no significant difference in the pain and discomfort subscales ( P > 0.05) between the 4 Hz and 20 Hz groups and there were significantly lower pain and discomfort scores in the 4/20 Hz group ( P < 0.05) compared to the 4 Hz and 20 Hz groups. There was no significant difference in the reduction of urination symptoms and quality of life among the three groups ( P > 0.05). Compared with before treatment, IIEF-5 scores of the three groups were improved ( P < 0.05). After treatment, there was no significant difference between the IIEF-5 scores in 4 Hz and 20 Hz ( P > 0.05), while the IIEF-5 score in 4/20 Hz was significantly higher than that in 4 Hz and 20 Hz, and the change was significant ( P < 0.05). The HADS scores decreased in all the three groups ( P < 0.05), but there was no significant difference in HADS scores between the three groups ( P > 0.05). Adverse events were mild and transient, and no serious adverse events occurred in each group. Both the expansive and continuous waveforms of EA can effectively alleviate symptoms such as prostatitis, erectile dysfunction, anxiety, and depression in patients with CP/CPPS. Expansion waves are superior to continuous waves in improving erectile function and pain symptoms in chronic prostatitis and can be used as a preferred waveform for the treatment of CP/CPPS. Trial Registration. This trial is registered with Chinese Clinical Trial Registry, ChiCTR2100044418., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2022 Zhihao Li et al.)

The study was designed and conducted to evaluate the plant-based diet status and its association with erectile function (EF) in Chinese young healthy men. From July 2018 to May 2020, 116 objectively proved physically and psychologically healthy men were selected. Clinical questionnaires, detailed physical examinations and blood tests were all assessed. An overall plant-based diet index (PDI) and a healthful plant-based diet index (hPDI) were developed from each participant to measure plant-based diet quantitatively. The EF was measured by both the International Index of Erectile Function-5 (IIEF-5) and the surrogated measures of endothelial function, peripheral levels of nitric oxide (NO) and E-selectin. In subjects, the mean PDI and hPDI were 53.8 ± 8.2 and 54.7 ± 8.9 respectively. Results of multivariate analysis showed that both PDI and hPDI were negatively associated with BMI (all p < .05), but had no relationships with NO, E-selectin, TT levels and IIEF-5 scores (all p > .05). In a subgroup of male population, Chinese young healthy men, the plant-based diet, measured by PDI and hPDI, was not related to erectile function. The population can adhere to plant-based diet to keep healthy without concerns of negative influence on erectile function., (© 2021 Wiley-VCH GmbH.)

This study aimed to assess the association between psychological disorders and erectile dysfunction (ED) in patients with different degrees of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This was a retrospective study conducted from June 2017 to October 2019 and included 182 outpatients. Patients were interviewed using the Structured Interview on Erectile Dysfunction (SIEDY) for pathogenic quantification. The National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Index of Erectile Function-5 (IIEF-5) were used for the evaluation of CP/CPPS and ED. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety symptoms and depressive symptoms. The number of patients with mild CP/CPPS and mild ED, mild CP/CPPS and moderate-to-severe ED, moderate-to-severe CP/CPPS and mild ED, and moderate-to-severe CP/CPPS and moderate-to-severe ED was 69 (37.9%), 36 (19.8%), 35 (19.2%), and 42 (23.1%), respectively. The corresponding PHQ-9 scores of the four groups were 6.22, 7.19, 10.69, and 7.71, respectively. The corresponding GAD-7 scores of the four groups were 5.26, 6.31, 8.77, and 6.36, respectively. Among patients with moderate-to-severe CP/CPPS, the PHQ-9 and GAD-7 scores of the moderate-to-severe ED group were significantly lower than those of the mild ED group (P = 0.007 and P = 0.010, respectively). The prevalence of ED and premature ejaculation (PE) in patients with moderate-to-severe CP/CPPS was significantly higher than that in patients with mild CP/CPPS (P = 0.001 and P = 0.024, respectively). Our findings proved that the severity of ED was negatively associated with psychological symptoms in outpatients with moderate-to-severe CP/CPPS., Competing Interests: None

The purpose of this study was to develop an erectile dysfunction (ED) risk assessment tool suitable for the general population. Based on an ED network survey of the general adult male population in China from October to November 2019, a total of 612 cases with a mean age of 31 years (interquartile range: 28-37) with valid data were collected: 357 cases were assigned to the training set and 255 to the validation set. The ED risk prediction model was established by multifactor logistic regression analysis, and nomograms were constructed for visualisation. In the validation set, a receiver operating characteristic curve, calibration curve analysis and decision curve analysis were used to evaluate the discrimination, calibration and clinical usefulness of the ED risk prediction model. Based on multivariate logistic regression, education, smoking, chronic diseases, feelings about one's spouse, frequency of sexual intercourse, masturbation and self-reported sexual satisfaction were selected as predictors to develop the ED prediction model. The model had good discrimination, calibration and clinical applicability. The ED risk prediction model developed in this study can effectively predict ED risk in the general population., (© 2020 Wiley-VCH GmbH.)

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.)

This study explored the relationships between the decline in sexual function and psychological burdens and life satisfaction in older men with the aim of providing prospective targets for interventions. From January 2016 to January 2019, we selected 1,326 men aged over 50 years old. We adopted the International Index of Erectile Function-5 (IIEF-5), self-estimated intravaginal ejaculatory latency time (IELT), the premature ejaculation diagnostic tool (PEDT), the General Anxiety Disorder-7 (GAD-7), the Patients Health Questionnaire-9 (PHQ-9), the satisfaction with life scale and the control, autonomy, self-realisation and pleasure scale (CASP-19) to measure premature ejaculation, erectile dysfunction and well-being (including, depression, anxiety, and life quality and satisfaction) respectively. The individuals were divided into two main groups: the decline group and the no-decline group. The incidences of erectile dysfunction (ED), premature ejaculation (PE), anxiety and depression in men who reported a decline in sexuality were 73.83% (330/447), 63.98% (286/447), 75.84% (339/447) and 68.46% (306/447) respectively. Men who showed a decline in sexuality had significantly worse psychological and life satisfaction/quality scores than those in the no-decline group (p < .001 for all). When they had PE or ED simultaneously, these differences widened. Significantly worsened psychological status and life quality/satisfaction scores could be observed in patients who had declined sexual desire and declined frequency of sex (p < .001 for both). Under the impact of the decline in sexual function, the younger participants (age < 60) had significantly worsened negative emotions and life quality and satisfaction. Based on the results of the study, we found that the decline in sexuality was associated with depression and anxiety and worse life satisfaction and quality. Clinicians need to pay more attention to psychological status and life satisfaction and quality for those patients affected by a decline in sexuality., (© 2020 Blackwell Verlag GmbH.)

Introduction: Prior epidemiology studies on erectile dysfunction (ED) have varied in geography/place, time period, and methodology. Due to this variability, comparisons of data across studies are greatly limited. Additionally, little is known about the rates of comorbid ED and benign prostatic hyperplasia (BPH)., Aim: To update the prevalence of ED and patient characteristics using a single methodology in 8 countries: Brazil, China, France, Germany, Italy, Spain, the United Kingdom, and the United States., Methods: This retrospective cross-sectional study included men (≥18 years) who self-reported experiencing difficulty in achieving or maintaing an erection in the past 6 months in the 2015 and 2016 National Health and Wellness Surveys (N = 97,159). Pairwise comparisons between the United States and each of the other countries were performed among respondents with ED and no BPH, aged ≥18 years, and within the subset of men aged 40-70 years., Main Outcome Measures: ED prevalence (with BPH, with no BPH, and overall), health characteristics, and ED risk factors were assessed., Results: ED with BPH was found to be < 6.0% in all countries. ED prevalence overall varied from 37.2% (Brazil) to 48.6% (Italy). Similar patterns were observed for the subset of men aged 40-70 years. Patients in Brazil were younger (aged ≥18: 43.85 vs. 52.35; aged 40-70: 52.94 vs. 56.76 years; for both, P < .05) than those in the United States. ED-related comorbidities were more common in European countries, comparatively., Conclusion: This study provides an important update and outlook to ED epidemiology in Brazil, China, France, Germany, Italy, Spain, the United Kingdom, and the United States. Overall, ED prevalence is high, relative to some previous estimates. Findings from this study highlight the continued burden ED plays in the lives of men in these countries. Goldstein I, Goren A, Li VW, et al. Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden. Sex Med Rev 2020;8:48-58., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess sexual life and medication taking behaviours in young Chinese men., Methods: An online survey was conducted across China between January 2017 and April 2017. Among the participants, men aged 19-40 years were included in the analysis. The respondents filled in the online questionnaire assessing sexual life and medication taking behaviours by themselves, including general information, cognition of erectile dysfunction (ED) and treatment-related questions. Erection hardness score (EHS) was used to measure the erection hardness status., Results: Among the young respondents, 20.54% had grade I-II EHS, 58.14% searched the internet for online ED-related information, 26.49% took an ED medication and 50.89% took an ED medication without the advice of a physician or pharmacist. The respondents who took medication had less sexual intercourse per week (P < .001) and worse EHS (P < .001), and were more willing to seek information from physicians, pharmacists, friends and relatives instead of online sources (P < .001), compared with those not taking medication. The most common comorbidities in patients with grade I-II EHS were hyperlipidaemia, cardiovascular disease (CVD), prostate diseases and diabetes mellitus., Conclusion: About 20% of young Chinese men needed further assessment for ED. The majority of respondents obtained ED-related information by online search and took an ED medication without professional advice. These data could help clinicians understand the current status of sexual life and medication taking behaviours of young Chinese men., (© 2019 John Wiley & Sons Ltd.)

Aim: To evaluate the association of erectile dysfunction (ED) with work productivity loss, activity impairment and health-related quality of life (HRQoL) across Brazil, China, France, Germany, Italy, Spain, the UK and the US., Methods: This cross-sectional observational study used data from adult men (40-70 years old; N = 52 697) from the 2015 and 2016 National Health and Wellness Surveys. ED assessment was based on self-reported difficulty in achieving or maintaining an erection in the past 6 months. Impairment to work and non-work activities and HRQoL were assessed for each country and compared against the US. Multivariable models tested interactions between ED status and country for each outcome., Results: Overall ED prevalence was reported as 49.7%, with Italy reporting the highest rate (54.7%). Men with ED reported significantly higher absenteeism (7.1% vs 3.2%), presenteeism (22.5% vs 10.1%), overall work productivity impairment (24.8% vs 11.2%), activity impairment (28.6% vs 14.5%) and significantly lower Mental Component Summary scores (MCS; 46.7 vs 51.2), Physical Component Summary scores (PCS; 48.3 vs 53.0), and health state utilities (SF-6D: 0.693 vs 0.778; all, P < 0.001) than men with no ED. After adjusting for covariates, compared with the US, the association of ED status with overall work productivity impairment was greatest in the UK (26% higher; P < 0.05), and with MCS, PCS and SF-6D scores was greatest in China (-2.67, -1.58, and -0.043 points, respectively; all, P < 0.001). Greater ED severity was significantly associated with higher impairment to work and non-work activities and lower HRQoL, with China reporting the highest burden, compared with the US (most P < 0.05)., Conclusion: ED poses a significant burden with respect to work productivity and HRQoL, with greater severity associated with worse outcomes. Better management and earlier detection may help reduce this burden, especially in countries reporting a strong association between ED and poor economic and health outcomes., (© 2019 John Wiley & Sons Ltd.)

Objectives: Prior studies of erectile dysfunction (ED) tend to narrowly focus on relationships with specific comorbidities, rather than evaluating a more comprehensive array of risk factors and assessing naturalistic patterns among them. This study identifies natural clusters of male characteristics from a general population sample per country, quantifies ED dynamics in these profiles and compares profiles across the US, Italy, Brazil and China samples., Methods: National Health and Wellness Survey 2015 and 2016 patient-reported data on men aged 40-70 years (USA n = 15,652; Italy n = 2,521; Brazil n = 2,822; China n = 5,553) were analysed. Hierarchical agglomerative clustering identified clusters where predictors included demographics, health characteristics/behaviours, ED risk factors and provider visits in the past 6 months. Multinomial logistic regression assessed the independent utility of variables in predicting cluster membership, compared with the healthiest control cluster per country., Results: Different natural clusters were found across countries, with four clusters for the USA, Italy and China and three clusters for Brazil. Age, income, employment, health behaviours and ED risk factors predicted different cluster membership across countries. In the USA, Italy and Brazil, younger clusters were predicted by ED, unhealthy behaviours and ED risk factors. Unique cluster profiles were identified in China, with ED and ED risk factors (aside from hypertension) not predicting cluster membership, while socio-demographics and health behaviours were strongly predictive., Conclusions: Natural cluster profiles revealed notable ED rates among adult males of age 40-70 in four different countries. Clusters were mainly predicted by unhealthy behaviours, ED risk factors and ED, regardless of level or presence of positive health characteristics and behaviours. This analysis identified meaningful subgroups of men with heightened ED risk factors, which can help healthcare providers to better recognise specific populations with the greatest need for intervention., (© 2019 John Wiley & Sons Ltd.)

Objective: To analyze the basic characteristics and related factors of ED., Methods: Using the self-designed National Key Collaboration Platform for Impotence Disease Research, we enrolled 297 ED males at the urological clinic of the Second Hospital of Zhejiang University of Chinese Medicine from January 2015 to August 2018, and analyzed their basic characteristics, IIEF-5 scores, and erection hardness grades based on the Erectile Hardness Grading Scale., Results: The patients were aged 21－81 years, 41.4% at the age of 31－40 years, 81.5% with a disease course of less than 5 years, 56.9% with mild ED, and 44.8% with grade-3 erectile hardness. The IIEF-5 scores were significantly lower in the patients over 60 years old than in those aged 31－40 years (13.82±5.36 vs 8.50±4.99, P < 0.05), in those with a disease course of <5 years than in those with a disease course of >10 years (P < 0.05), and in those with a poor than in those with a loving relationship (P < 0.05), but showed no statistically significant difference among those with different marital status (P > 0.05)., Conclusions: The severity of ED is related to age, course of disease and mutual affection between the partners, but not to marital status.

Objectives: Erectile dysfunction (ED) affects up to 53.4% of men aged 30-80 years. In this study, we aimed to examine the association between homocysteine (HCY), vitamin B 12 (B12), folic acid (FA) and ED., Design: Cross-sectional study., Setting: Guangxi, China., Participants: A total of 1381 participants who completed questionnaires were included, between September 2009 and December 2009., Measures: ED was evaluated by the International Index of Erectile Function scores. Also, the values of HCY, B12 and FA were acquired. Then, regression and between-group analyses were performed., Results: No association between FA and ED was found. Significant correlations between HCY and ED were found-the relationships between these two parameters were most notable in men aged over 60 years and in men living alone (bachelors or bachelorhood). B12 levels were higher in men with ED (718.53±234.37 pg/mL vs 688.74±229.68, p=0.015). Using multinomial logistic regression analyses, B12 levels were related to mild ED (multivariate adjusted analysis: OR 1.620, 95% CI 1.141 to 2.300, p=0.007), especially among men aged 40-49 years (OR 2.907, 95% CI 1.402 to 6.026, p=0.004)., Conclusions: We report, for the first time, a relationship between B12 levels and ED. We also found specific cohorts of men for whom the relationship between HCY levels and ED is most prominent. Further studies are required to elucidate the mechanisms underlying these relationships-these may ultimately result in new therapies for ED., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Inflammation has been known to affect endothelial function and is involved in the progression of erectile dysfunction (ED). Thus, our present study was conducted to investigate the association between inflammatory marker high-sensitivity C-reactive protein (hs-CRP) and ED in a Chinese male population. A total of 1515 participants with anthropometric measurements, serum analyses and hs-CRP values available were included in our cross-sectional study. Data involving socioeconomic and lifestyle factors were also collected. ED was assessed by the 5-item International Index Erectile Function (IIEF-5), and hs-CRP levels were measured by the immunoturbidimetric assay. Logistic regression was applied to estimate the association between the serum hs-CRP and the risk of ED, and receiver operating characteristics (ROC) curve analysis was performed to identify the predictive value of hs-CRP. Serum hs-CRP levels were significantly higher in ED patients, and increased progressively with the incremental severity of ED (P < 0.001 for trend). In the multivariate-adjusted model, men in the highest quartile of hs-CRP level versus those in the lowest quartile had a 50% increased likelihood for ED (OR = 1.50; 95% CI = 1.08-2.08). When subjects were stratified by age, the risk of ED was more prominently in the middle-aged and elderly men. Based on the ROC analysis, serum hs-CRP has a poor diagnostic value for ED with an AUC of 0.58 (95% CI: 0.56-0.61) but has a good diagnostic performance for differentiating severe ED (AUC: 0.79; 95% CI: 0.77-0.81). Our study indicates that increased serum hs-CRP levels are associated with the severity of ED and an increased ED risk in a Chinese male population. These findings suggest that hs-CRP may be of value as an inflammatory marker for the assessment of ED risk and may play an important role in the etiology of ED.

The aim of this study was to estimate the prevalence and correlates of erectile dysfunction (ED) in a sample of Chinese type 2 diabetic men. Between October 2016 and April 2017, male patients with type 2 diabetes mellitus treated in our diabetes outpatient clinic were recruited in this study. The participants were asked to complete a short version of the International Index of Erectile Function (IIEF-5), which was a validated and self-administered questionnaire for the diagnosis and grading of ED severity. All patients screened for erectile function also underwent detailed physical examination, and interviewed for demographic and medical history. A total of 550 men were recruited in this study, of whom 20 patients were excluded and 35 did not complete all scheduled study procedures, leaving 495 patients in the final analysis. As determined by IIEF-5 score, 318 (64.2%) patients had ED. Among the 318 patients with ED, mild, mild-to-moderate, moderate, and severe were 37 (11.6%), 65 (20.4%), 95 (29.9%), and 121 (38.1%), respectively. The prevalence of ED in patients with high education, secondary education, and less than secondary education were 83.3%, 60.2%, and 35.4%, respectively (P < 0.0001). The prevalence of ED was 64.2% in Chinese type 2 diabetic men. Increased age, longer duration of diabetes mellitus, and worse glycemic control may promote the progression of ED among Chinese type 2 diabetic men. We also found that the higher education levels may increase the risk of ED in men with type 2 diabetes mellitus.

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.)

Background: Knowledge on the occurrence of erectile dysfunction (ED) and timely ovulatory intercourse failure (TOIF) in Chinese men of infertile couples is limited., Aim: To obtain representative estimates of ED and TOIF in Chinese men of infertile couples and to analyze potential risk factors associated with ED., Methods: 4,299 Chinese men of infertile couples with an average age of 32.85 ± 5.98 years were surveyed using the 5-item International Index of Erectile Function (IIEF-5) questionnaire for their ED occurrence. Multiple logistic regression analysis was used to disclose risk factors associated with ED., Outcomes: The occurrence of ED was 57.8% and that of TOIF was up to 26.2% in Chinese men of infertile couples., Results: Based on IIEF-5 criteria, 34.9% of men had mild ED and only 2.6% had severe ED. Secondary infertility, infertility with known causes, and chronic prostatitis were significant risk factors associated with ED. TOIF was significantly higher (23.3%) in men of infertile couples with ED than in those without ED (8.6%), indicating that TOIF is likely a contributing factor to male infertility., Clinical Implications: Understanding the occurrence and types of ED and TOIF in men of infertile couples and their associated risk factors will help physicians treat clinical cases of male infertility more effectively., Strengths and Limitations: Large numbers of infertile outpatients from multiple hospital clinics across the country were included in this study. The concept of TOIF was raised for the 1st time and studied preliminarily in Chinese men of infertile couples. The lack of participants' psychological status, a control group of men of fertile couples, and measurement of testosterone levels was a limitation in this clinic-based study., Conclusion: The occurrence of ED was higher in Chinese men of infertile couples than in the general Chinese male population. Yang B, Xu P, Shi Y, et al. Erectile Dysfunction and Associated Risk Factors in Chinese Males of Infertile Couples. J Sex Med 2018;15:671-677., (Copyright © 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Background: There is a lack of nationwide epidemiologic survey data on the prevalence estimate of erectile dysfunction (ED) in Chinese men living on the mainland China., Aim: To attain the representative prevalence estimate of ED in the Chinese male population and to analyze potential risk factors associated with ED by demographics, socioeconomic status, and medical comorbidities., Methods: The study was community based. The five-item Internation Index of Erectile Function questionnaire and in-person interview were used to obtain data. The survey subjects were 5,210 non-institutionalized Chinese men at least 40 years old residing in 30 provinces and autonomies of China. Multiple logistic regression analysis was used to disclose risk factors associated with ED., Outcomes: The prevalence estimate of ED was 40.56% in Chinese men at least 40 years old., Results: The prevalence of ED increased with increasing age. A significant high prevalence of ED was observed in men who smoked heavily, were estranged from a partner, had diabetes, and lower urinary tract symptoms from benign prostatic hyperplasia. Smoking more than 30 cigarettes daily and obesity (body mass index ≥ 30 kg/m 2 ) significantly increased the risk for ED by multivariable-adjusted odds ratios. Stable or erratic sexual partners, personal incomes, alcohol consumption, and cardiovascular and/or cerebrovascular diseases were not risk factors associated with ED prevalence. Other sexual problems commonly seen in this group of men included difficulty achieving erectile rigidness, ejaculation, and climax during intercourse., Clinical Translation: Knowledge on the prevalence of ED and its associated risk factors will help physicians in the clinical management and prevention of ED with the use of counseling for lifestyle adjustment and drug therapy., Strengths and Limitations: Data on the influence of psychological conditions on ED were not collected. ED was not categorized as minor, moderate, or severe for analysis during processing of data., Conclusion: The national representative prevalence of ED was determined for the first time in the Chinese male population. Zhang X, Yang B, Li N, Li H. Prevalence and Risk Factors for Erectile Dysfunction in Chinese Adult Males. J Sex Med 2017;14:1201-1208., (Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the prevalence of erectile dysfunction (ED) in men with pre-diabetes., Methods: This study included 500 men with impaired fasting glycaemia (IFG), 500 with impaired glucose tolerance (IGT), and another 500 with normal blood glucose (NBG), all from Lanzhou. We conducted a questionnaire investigation among the subjects using the International Index of Erectile Dysfunction 5 (IIEF-5)., Results: The prevalence rates of ED in the IFG, IGT, and NBG groups were 14.8%, 29.2%, and 33.2%, respectively. After controlling for age, nationality, occupation, education, income, obesity, and blood pressure, the incidence rate was markedly higher in the IFG and IGT than in the NBG group (29.2% and 33.2% vs 14.8%, P <0.05), but showed no statistically significant difference between the IFG and IGT groups (P >0.05)., Conclusions: The prevalence of ED is higher in men with pre-diabetes than in those with normal blood glucose in Lanzhou.

Introduction: The decline of testosterone has been known to be associated with the prevalence of erectile dysfunction (ED), but the causal relationship between sex hormones and ED is still uncertain., Aim: To prove the association between sex hormones and ED, we carried out a prospective cohort study based on our previous cross-sectional study., Methods: We performed a prospective cohort study of 733 Chinese men who participated in Fangchenggang Area Males Health and Examination Survey from September 2009 to December 2009 and were followed for 4 years. Erectile function was estimated by scores of the five-item International Index of Erectile Dysfunction (IIEF-5) and relative ratios (RRs) were estimated using the Cox proportional hazards regression model., Main Outcome Measures: Data were collected at follow-up visit and included sex hormone measurements, IIEF-5 scores, physical examination, and health questionnaires., Results: Men with the highest tertile of free testosterone (FT) (RR = 0.21, 95% confidence interval [CI]: 0.09-0.46) and the lowest tertile of sex hormone-binding globulin (SHBG) (RR = 0.38, 95% CI: 0.19-0.73) had decreased risk of ED. In young men (aged 21-40), a decreased risk was observed with the increase of FT and bioavailable testosterone (BT) (adjusted RR and 95% CI: 0.78 [0.67-0.92] and 0.75 [0.62-0.95], respectively). Total testosterone (TT) (RR = 0.89, 95% CI: 0.81-0.98) was inversely associated with ED after adjusting for SHBG, while SHBG (RR = 1.04, 95% CI: 1.02-1.06) remained positively associated with ED after further adjusting for TT. Men with both low FT and high SHBG had highest ED risk (adjusted RR = 4.61, 95% CI: 1.33-16.0)., Conclusions: High FT and BT levels independently predicted a decreased risk of ED in young men. Further studies are urgently needed to clarify the molecular mechanisms of testosterone acting on ED., (© 2015 International Society for Sexual Medicine.)

Objectives: The study was to investigate the prevalence and associated factors of erectile dysfunction (ED) in peritoneal dialysis (PD) patients., Methods: This was a cross-sectional survey. Eligible patients were interviewed by questionnaire: the five-item version of International Index of Erectile Function. Residual renal function (RRF) was assessed by daily urine volume and residual glomerular filtration rate., Results: Totally, 176 male prevalent PD patients were interviewed, six of them were not included in analysis for sexually inactive unrelated to ED. The prevalence of ED was 80.6 %. After adjusting for confounding factors, advance age (P = 0.014), less daily urine volume (P = 0.032) and higher high-sensitivity C-reactive protein (hs-CRP) (P = 0.043) were independent risk factors for the development of ED., Conclusion: The prevalence of ED was high in Chinese PD patients. Advanced age, poor RRF and higher hs-CRP were independently associated with the prevalence of ED.

The purpose of the study is to evaluate the relationship between NIH-CPSI and IIEF-5 in Chinese men with CP/CPPS. A large cross-sectional and multicenter survey was conducted from July 2012 to January 2014. Men were recruited from urology clinics which were located at the five cities in China. All men participated in the survey by completing a verbal questionnaire (consisted of sociodemographics, past medical history, sexual history, and self-estimated scales). The results showed that 1,280 men completed the survey. Based on the CP/CPPS definition, a total of 801 men were diagnosed as having CP/CPPS. Men with CP/CPPS reported higher scores of NIH-CPSI and lower scores of IIEF-5 than men without CP/CPPS. NIH-CPSI scores were significantly negatively correlated with IIEF-5 scores. The total scores of NIH-CPSI were significantly more strongly correlated with question 5 than other questions of IIEF-5. The total scores of IIEF-5 were significantly more strongly correlated with pain symptoms scores of NIH-CPSI. Strongest correlation was found between QoL impact and question 5 of IIEF-5. The findings suggested that NIH-CPSI scores were significantly negatively correlated with IIEF-5 scores. Strongest correlation was found between QoL impact and question 5 of IIEF-5.

Background: The aim of this study was to investigate the correlation between incidence of lower urinary tract symptoms and erectile dysfunction in men aged ≥50 years., Material and Methods: A cross-sectional study was performed in 1644 men aged >50 years in Beijing. The International Index of Erectile Function (IIEF)-5 and International Prostate Symptom Score were recorded for each patient. Pearson's chi-square test and Spearman correlation coefficients were used to analyze the International Prostate Symptom Scores and lower urinary tract symptoms, and their correlations with erectile dysfunction., Results: The incidence rates of erectile dysfunction among men with mild, moderate, and severe lower urinary tract symptoms were 85.7, 93.7, and 97.9%, respectively. Interestingly, the total IIEF-5 score significantly correlated with the total International Prostate Symptom Score (r=-0.335; P<0.01), obstructive symptoms (r=-0.276; P<0.01), and irritative symptoms (r=-0.326; P<0.01). The correlation between the severity of lower urinary tract symptoms and that of erectile dysfunction was consistently maintained (r=0.304; P<0.01). Age significantly correlated with International Prostate Symptom Score (r=0.388; P<0.01), lower urinary tract symptoms severity (r=0.457; P<0.01), total IIEF-5 score (r=-0.533; P<0.01), and erectile dysfunction severity (r=0.529; P<0.01)., Conclusions: The incidence of lower urinary tract symptoms and erectile dysfunction in aging men increase with age, and the severity of erectile dysfunction is positively correlated with the severity of lower urinary tract symptoms.

Introduction: Chronic prostatitis (CP) is a frequent prostate-related complaint, impacts negatively on quality of life and is mostly of unclear etiology. Increasing attention has been paid to the prevalence of sexual dysfunctions in CP patients; however, the impact of specific types of CP and the correlation of sexual dysfunctions with psychological disorders associated with CP are not well understood. Type IIIa CP is characterized by chronic pelvic pain, urination symptoms and white blood cells in expressed prostatic secretion, but free of bacterial infection., Methods: A population of 600 type IIIa CP patients were randomly selected and 40 normal man were included as the control group. Queries were conducted by urologists. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function (IIEF-5) and the Symptom Checklist 90-R were used to evaluate the symptoms and severity of prostatitis, erectile dysfunctions and psychological problems, respectively. Scores of ejaculatory pain and premature ejaculation were also collected., Results: Our study revealed that sexual dysfunctions are frequently associated with this specific type of CP. The prevalence of erectile dysfunction, premature ejaculation and ejaculatory pain was 19, 30 and 30 %, respectively. A variety of psychological problems exist among type IIIa CP patients, including depression, anxiety, somatization, obsessive-compulsive and interpersonal sensitivity. In particular, the severity of erectile dysfunctions, but not premature ejaculation and ejaculatory pain, correlated significantly with depression and anxiety., Conclusion: Our data indicate that a moderate level of sexual dysfunctions exists among the type IIIa CP patients, and highlight the association of depression and anxiety with erectile dysfunction in CP patients, suggestting that special attention should be paid to these psychological issues in clinical treatments of the prostatitis symptoms and the associated erectile dysfunctions.

To investigate the prevalence, correlates, attitude and treatment seeking behavior of erectile dysfunction (ED) in type 2 diabetes mellitus (T2DM) patients in the primary care setting, a multi-center cross-sectional survey using a structured anonymous self-administered questionnaire was performed in 10 general outpatient clinics. Of the 603 subjects (91% response rate), the prevalence of ED men, as defined by the International Index of Erectile Function, was 79.1%. Most subjects had mild ED (28.9%), followed by mild-to-moderate ED (27.9%), then moderate ED (13.4%) and severe ED (9%). Nearly 55% of those with ED did not consider themselves as having ED. Less than 10% of them had ever sought medical treatment, although 76.1% of them wished to receive management from doctor(s) should they be diagnosed with ED. They considered the most important management from doctors to be clinical assessment (41.7%), followed by management of potential underlying cause (37.8%), referral to specialist (27.5%), education (23.9%), prescription of phosphodiesterase type 5 inhibitors (16.9%) and referral to counseling service (6.7%). The prevalence of ED was strongly associated with subjects who thought they had ED (odds ratio (OR) = 90.49 (20.00-409.48, P< 0.001)) and were from the older age group (OR = 1.043 (1.011-1.076, P= 0.008)). In conclusion, ED is highly prevalent among T2DM men. The majority of them wanted management from doctors should they have ED, but only a minority would actually voice out the request. Screening of ED among T2DM men using structural questionnaire allowed the diagnosis of more than half of the ED cases, which otherwise would have gone undiagnosed.

Objectives: The purpose of this study is to investigate the possible underlying pathogenesis of erectile dysfunction (ED) without well-known etiology in young men under the age of 40 years., Methods: 192 patients and 33 normal controls were enrolled. ED was evaluated by using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Traditional cardiovascular risk factors, hormone levels, and vascular parameters were measured. Insulin resistance (IR) was measured by homeostasis model assessment (HOMA)., Results: Patients with ED had significantly higher levels of systolic blood pressure (SBP), high-sensitivity C-reactive protein (Hs-CRP), high Insulin resistance index (HOMA-IR) and carotid intima-media thickness (IMT), compared with controls. The brachial artery endothelium-dependent flow-mediated vasodilation (FMD) values were significantly lower in ED patients. By multivariate logistic regression analysis, FMD, SBP, Hs-CRP and HOMA-IR were significantly associated with ED. In receiver-operating characteristic (ROC) analysis, FMD was a significant predictor of ED (area under the curve (AUC) 0.933, p < 0.001). The cutoff value of FMD <10.4 % had sensitivity of 81.3 % and specificity of 100 %. HOMA-IR was also proven to be predictor of ED (AUC of HOMA-IR 0.759, p < 0.001)., Conclusions: ED may be the first clinical sign of endothelial dysfunction and a clinical marker of cardiovascular and metabolic diseases. Subclinical endothelial dysfunction and insulin resistance may be the underlying pathogenesis of ED in young patients without well-known etiology. Measurement of FMD, HOMA-IR can improve our ability to predict and treat ED, as well as subclinical cardiovascular disease early in young men.

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.

Objective: To investigate the epidemiology of late-onset hypogonadism (LOH) in old and middle-aged males in the rural area of Southern China., Methods: Using the age-stratified sampling method, we conducted a questionnaire investigation on androgen deficiency in aging males (ADAM), aging male symptoms (AMS) and IIEF-5 among 996 males aged 40 -80 years in a rural community of Jiashan county, Zhejiang Province from April to October 2012. We also determined the concentrations of serum total testosterone (TT), serum sex hormone binding globulin (SHBG) and serum albumin (ALB), detected the levels of free testosterone (cFT) and bio-available testosterone (Bio-T) by Vermeulen formula, and measured the volumes of the prostate and testis by ultrasonography., Results: The mean age of the males was 56.22 +/- 8.82 years. The positive rates of LOH were 62.86% and 23.05% based on ADAM and AMS, respectively, and the incidence of erectile dysfunction (ED) was 68.83%. There were significant differences among different age groups in the levels of luteinizing hormone (LH), SHBG, cFT and Bio-T, but not in TT concentration., Conclusion: Ours was the first survey on the epidemiology of LOH among old and middle-aged males in the rural area of China. The incidence of LOH in the rural community of Zhejiang Province was lower than that in the urban areas reported in other studies, but the positive rate of ED showed no significant difference.

Objective: To investigate and compare the prevalence of erectile dysfunction, hyposexuality and ejaculation disorder among middle-aged and older males in the urban and suburban areas of Beijing., Methods: Using the random sampling method, we selected 1 656 men aged > or = 50 years from 15 communities in Beijing. We recorded their scores on the International Index of Erectile Function-5 (IIEF-5) and Brief Male Sexual Function Inventory for Urology (O'Leary 1995), and analyzed the obtained data using SPSS 17.0., Results: Totally, 1 644 of the subjects were qualified for the study, 1 244 from the urban area and the other 400 from the suburbs. The median scores on IIEF-5, sexual desire and ejaculation were 5, 2 and 4 in the urban males as compared with 13, 2 and 5 in the suburban men, with statistically significant differences between the two groups (P < 0.01). The IIEF-5 score was significantly correlated with age, diabetes, cardio-cerebrovascular diseases, drinking and administration of 5alpha-reductase inhibitor in both the urban and suburban groups (P < 0.01)., Conclusion: The sexual function of the middle-aged and older males is better in the suburbs than in the urban area of Beijing. The main reasons might be the lower incidences of diabetes and cardio-cerebrovascular diseases, moderate drinking and less use of 5alpha-reductase inhibitor among the suburban men.

Objectives: Erectile dysfunction (ED) is common among methadone-maintained patients and reduces their quality of life. This study reports the prevalence of ED among male heroin addicts receiving methadone maintenance treatment (MMT) in China and describes factors that may contribute to ED., Methods: Seventy-four male heroin addicts enrolled in 4 MMT clinics for the first time were interviewed about general baseline characteristics. Scales for assessing erectile function and psychological disorders were completed monthly. Blood was drawn for serum hormone-level measurement at the baseline and at a 3-month follow-up. Daily methadone dosages were recorded by physicians., Results: Erectile dysfunction was reported in 75.7%, 88.7%, 80.8%, and 80.9% of the patients at the baseline, 1-, 2-, and 3-month follow-ups, respectively. No significant differences in the prevalence of ED were found during the course of treatment. About two-thirds of the patients who had ED at the 3-month follow-up had had the condition while on heroin. The delayed erectile function was significantly associated with duration of treatment (odd ratio, OR1-month vs baseline = 1.86, P = 0.021; OR2-month vs baseline = 1.67, P = 0.066) and methadone dosage (OR = 1.02, P = 0.038). Ongoing substance, serum hormone levels, and psychological disorders were not associated with ED., Conclusions: The prevalence of ED among male methadone-maintained patients in China is very high and individuals with altered erectile function while on heroin represent a high-risk group for the development of ED upon initiation of MMT. In the setting of delayed erectile function after receiving methadone, a trial of dosage reduction and symptomatic treatments may be a reasonable initial approach.

This study was aimed to investigate the influence of coital frequency and masturbation on erectile dysfunction (ED) in Chinese patients. A total of 332 male outpatients with or without ED and volunteers were recruited from Zhongnan Hospital, Wuhan University, China. ED was assessed by using the five-item International Index of Erectile Function scale and the frequency of intercourse by patients' self-report. After adjusting for lifestyle factors and diseases-related factors, the analyses showed that coital and masturbation in a certain frequency tended to decrease the risk of ED. Men reporting intercourse once a week had lower risk of ED than those did less than once a week, with age, hyperlipidemia, hypertension, diabetes, body mass index, smoking, and drinking as covariates (P=0.67, adjusted odds ratio [OR] = 0.84; 95% confidence interval [CI]: 0.37-1.88). For those reporting coital frequency two times per week and three or more times per week, there were 63% (adjusted OR = 0.37; 95% CI: 0.18-0.77) and 85% (adjusted OR = 0.15; 95% CI: 0.07-0.35) lower risk of ED than those reporting intercourse frequency less than once per week, respectively (P<0.05). Results indicated that maintaining a regular frequency of intercourse can reduce the risk of ED for males aged among 30 to 75 years.

Objective: To assess the pathophysiologic composition and age structure of erectile dysfunction (ED) in men visiting outpatient clinics in China., Methods: We studied 3327 consecutive ED outpatients (median age 39 years) from 2006 to 2010 in the 5 training hospitals in China. Every patient was independently evaluated by an experienced urologist/andrologist using comprehensive diagnostic procedures. The simplified International Index of Erectile Function was used to assess the severity of ED., Results: Most patients (95.0%) were <60 years old, and none were >70 years old. The psychogenic patients were younger and had greater percentage than any other patients. Vasculogenic factors were a major etiology of organic ED. A significant difference was found in the age distribution between the patients with psychogenic ED and those with organic ED (P = .000). Diabetes, hypertension, coronary artery disease, and hyperlipidemia played significant roles in affecting the severity of ED in a statistical model, including age. The International Index of Erectile Function scores decreased with age (rs = -0.199, P = .000). Moreover, the percentage of severe and moderate cases increased with age (P = .003 and P = .002, respectively). However, the constituent ratio of patients sharply declined from 30.3% to 4.5% with age., Conclusion: The number of men visiting outpatient clinics with psychological ED is greater than the number with organic causes in China. The age of the Chinese patients with ED who seek medical help is young and this is mainly because of inadequate sex education to young men and because most older patients are reluctant to visit the hospital just for the loss of erectile function., (Copyright © 2012 Elsevier Inc. All rights reserved.)

To describe the prevalence of erectile dysfunction (ED) and its association with smoking and other risk factors among a large male population. Data were collected from 2686 men attending the Fangchenggang Area Male Health and Examination Survey from September 2009 to December 2009. ED was assessed using the 5-item International Index of Erectile Function. Self-reported smoking history was obtained from the questionnaire. Prevalence of ED was 49.5% among 2686 Chinese men in Fangchenggang aged 20-79 years. After adjusting for age, alcohol drinking, physical activity, hypertension, diabetes, dyslipidemia, and obesity, smokers who smoked ≥20 cigarettes daily had a significantly increased risk of ED than never smokers (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.03-1.49; P = .02). After further adjustment for education, the risk of ED was still significantly higher in men smoking more than 23 years than never smokers (OR, 1.60; 95% CI, 1.22-2.09; P = .001). Association of age and education with ED was statistically significant after adjusting for the other variables. A history of diabetes and hypertension all increased the risk of ED, but statistically significant differences did not exist after adjustment for other variables. The association between smoking and ED risk in men was higher with a habit of drinking alcohol (OR, 1.32; 95% CI, 1.01-1.74) or physical inactivity (OR, 1.33; 95% CI, 1.05-1.67), or with a with a history of hypertension (OR, 1.71; 95% CI, 1.11-2.62), dyslipidemia (OR, 1.39; 95% CI, 1.06-1.81), and diabetes (OR, 2.69; 95% CI, 1.4-6.98). Our results show that heavy smoking might cause ED and that the duration of the habit increases the risk of ED. Furthermore, it highlights the potential interaction of smoking with other life habits or medical history on ED risk.

Objective: To survey the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in males aged ≥ 50 years and explore the correlation between LUTS and ED., Methods: A cross-sectional study was performed at Beijing communities in 1644 males aged over 50 years. The International Index of Erectile Function-5 (IIEF-5) and International Prostate Symptom Score (IPSS) were recorded. Pearson's χ(2) test and Spearman correlation coefficients were used to analyze the results of IPSS, LUTS and their correlations with ED., Results: The mean age was 64.5 years old (range: 50-93), the mean value of IPSS(9.9 ± 8.2), the prevalence of mild, moderate and severe LUTS 49.2% (809/1644), 36.4% (599/1644) and 14.4% (236/1644) respectively. The mean value of IIEF was (9.4 ± 8.6), the total incidence of ED 90.5% (1487/1644) and the incidence of ED of mild, moderate and severe LUTS 85.7% (694/809), 93.7% (561/599) and 97.9% (231/236) respectively. The total IIEF-5 score was found significantly correlated with the total IPSS score (r = -0.335, P < 0.01), the obstructive symptoms (r = -0.276, P < 0.01)and irritative symptoms (r = -0.326, P < 0.01). The severity of LUTS was correlated with the severity of ED (r = 0.304, P < 0.01). Correlations also existed between age and total IPSS score(r = 0.388, P < 0.01), LUTS severity (r = 0.457, P < 0.01), total IIEF score (r = -0.533, P < 0.01) or ED severity (r = 0.529, P < 0.01)., Conclusion: The incidence of LUTS or ED in aging males increases with age. The severity of ED is positively correlated with the severity of LUTS. Irritative and obstructive symptoms influence the occurrence of ED in aging males.

Objectives: Our goal was to evaluate the association between erectile dysfunction (ED) and risk of cardiovascular disease (CVD) and all-cause mortality by conducting a meta-analysis of prospective cohort studies., Background: Observational studies suggest an association between ED and the incidence of CVD. However, whether ED is an independent risk factor of CVD remains controversial., Methods: The PubMed database was searched through January 2011 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies, the characteristics of the study participants, exposure and outcome assessments, and control for potential confounding factors. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates., Results: Twelve prospective cohort studies involving 36,744 participants were included in the meta-analysis. The overall combined relative risks for men with ED compared with the reference group were 1.48 (95% confidence interval [CI]: 1.25 to 1.74) for CVD, 1.46 (95% CI: 1.31 to 1.63) for coronary heart disease, 1.35 (95% CI: 1.19 to 1.54) for stroke, and 1.19 (95% CI: 1.05 to 1.34) for all-cause mortality. Sensitivity analysis restricted to studies with control for conventional cardiovascular risk factors yielded similar results. No evidence of publication bias was observed., Conclusions: This meta-analysis of prospective cohort studies suggests that ED significantly increases the risk of CVD, coronary heart disease, stroke, and all-cause mortality, and the increase is probably independent of conventional cardiovascular risk factors., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the prevalence of hyposexuality, erectile dysfunction (ED) and defective ejaculation (DE) in the old and middle-aged males in Pingliang area., Methods: This investigation included 1 539 men aged > or = 50 years from 6 urban districts and 20 villages in the suburbs of Pingliang City, Gansu Province. We recorded and analyzed their scores on IIEF-5 and Brief Male Sexual Function Inventory for Urology (O'Leary 1995)., Results: A total of 1 230 subjects met the investigation criteria. They averaged 62.5 +/- 9.6 years of age (range 50-89 years), and were divided into four age groups: 50-59, 60-69, 70-79 and > or = 80 years. The mean scores on IIEF-5 were 0-25 (9.4 +/- 8.6), sexual desire 0-8 (2.3 +/- 2.1), and ejaculation 0-8 (3.6 +/- 3.0). Hyposexuality, ED and DE were defined as sexual desire score < or = 2, IIEF-5 score = 0-21, and ejaculation score < or = 2, respectively. Based on these criteria, the incidence rates of hyposexuality, ED and DE were 57.96%, 92.27% and 36.91%, respectively, with statistically significant differences among different age groups (P < 0.01)., Conclusion: The prevalence of ED, hyposexuality and DE, particularly the incidence of ED, is positively correlated with the increase of age in the old and middle-aged males in Pingliang area.

Andrology has a long history in traditional Chinese medicine. There are records of male sexual health, male sexual dysfunction and male infertility from over thousands of years ago. Modern andrology in China had a late start, with the Chinese Andrology Association founded in 1995. Within last decade, andrology in China has grown rapidly. In this review article, we summarized the progress of andrology in last 10 years and outlined the current status of Chinese andrology with a special focus on progress in male erectile dysfunction, prostate diseases, male infertility and male hormonal contraception.

Objective: To evaluate the prevalence and the risk factors of erectile dysfunction in a Chinese cohort of hemodialysis (HD) patients., Methods: 63 male hemodialysis patients were assigned to HD group and 47 health volunteers were recruited as controls. The International Index of Erectile Function (IIEF-5) was used to assess erectile dysfunction (ED). All data were obtained by patient interviews and medical chart review. We measured the blood sex hormone of all the patients and volunteers. We divided those under 50 years HD patients into two groups according to erectile function (EF) score, Group A: EF score>=12, no ED or mild ED; Group B: EF score<12, moderate or severe ED., Results: The incidence of ED was significantly higher and the erectile function score was significantly lower in the HD group than that in the control group. The level of follicle stimulating hormone, luteinizing hormone, prolactin, estradiol, progesterone were significantly higher and the level of testosterone was significantly lower in the HD group than that in the control group. Patients in Group A were younger and duration of dialysis were shorter than patients in Group B. The level of high density lipoprotein was higher and FSH was lower in Group A than that in Group B. A significant negative correlation was found between the EF score and the age, duration of dialysis, the level of FSH and PRL in the HD group. There was a positive correlation trend between EF score and T level, but this did not reach statistical significance (p>0.05). More patients had hypertension in the HD group., Conclusion: The age, duration of dialysis, hypertension, lipid disorder, the abnormality of hypothalamic-pituitary-gonadal axis were risk factors for ED in HD patients.

Erectile dysfunction (ED) is not uncommon, but frequently underdiagnosed in type 2 diabetic men. In this study, we aimed to explore the frequency and severity of ED in Chinese type 2 diabetic men using a structured questionnaire. We furthermore sought to investigate the associations of ED with diabetes-related complications and metabolic indices. A consecutive cohort of 313 Chinese type 2 diabetic men aged between 25 and 76 years attending a diabetic centre were recruited between October 2006 and June 2007. Of the study population, the frequency of ED was 39.3% according to the National Institutes of Health (NIH) Consensus Conference criteria, compared with 84.3% (41.7% of them having moderate to severe ED) as diagnosed by International Index of Erectile Function (IIEF-5) questionnaire. After adjusting for potential confounding factors by multivariable logistic regression, ED defined by NIH criterion was associated with advanced age [OR = 1.05 (95% CI 1.01-1.09), p = 0.012], the presence of diabetic retinopathy [OR = 2.43 (95% CI 1.27-4.66), p = 0.008] and coronary heart disease [OR = 2.63 (95% CI 1.21-5.70), p = 0.015]. ED defined by IIEF-5 was associated with advanced age [OR = 1.12 (95% CI 1.06-1.17), p < 0.0001], use of insulin therapy [OR = 2.94 (95% CI 1.12-7.73), p = 0.029] and urinary albumin-creatinine ratio [OR = 2.29 (95% CI 1.05-5.01), p = 0.037]. In conclusion, ED was highly prevalent in Chinese type 2 diabetic men and was associated with multiple cardiovascular risk factors and complications. Advanced age, use of insulin therapy, the existence of microvascular complications such as retinopathy, albuminuria and coronary heart disease were associated with ED. NIH criteria diagnosed a much lower rate of ED compared with IIEF-5. Overall, structured questionnaires are useful and objective tools to detect ED, which should prompt a comprehensive risk assessment in these subjects., (© 2010 The Authors. International Journal of Andrology © 2010 European Academy of Andrology.)

Objectives: The objectives of this study were to investigate the prevalence of erectile dysfunction (ED) among living donor kidney transplant (LDKT) recipients associated with chronic hepatitis B infection in China and to assess the effect of successful LDKT to improve ED., Materials and Methods: From January 2006 to May 2009, erectile function of 26 LDKT recipients associated with chronic hepatitis B infection (Group 1) was evaluated predialysis, during dialysis, and at 6 months posttransplantation using the International Index of Erectile Function, version 5 (IIEF-5). We enrolled 61 age-matched LDKT recipients without hepatitis B/C infection as a control group (Group 2)., Results: The prevalences of ED in Group 1 at predialysis, on dialysis, and 6 months posttransplantation were 23.1%, 80.7%, and 65.3%, respectively. Among Group 2, it was 4.9%, 72.1%, and 41.0%, respectively. The difference in ED between groups was significant at predialysis (P = .031) and 6 months posttransplantation (P = .037). Compared with the dialysis stage, the prevalence of ED at 6 months posttransplantation was significantly decreased in Group 2 (72.1% vs 41.0%; P = .001), but it was not significantly difference from Group 1 (80.7% vs 65.3%; P = .211)., Conclusions: The incidence of ED among hepatitis B recipients was higher than among hepatitis B/C-negative patients at the predialysis and posttransplantation stages. Kidney transplantation is a key treatment to reduce the prevalence of ED among hepatitis B/C-negative recipients, but not those with hepatitis B., (2010 Elsevier Inc. All rights reserved.)

Objectives: To investigate the prevalence of erectile dysfunction (ED) in living donors before and after nephrectomy in China., Methods: From January 2006 to December 2008, erectile function of 94 living donors was evaluated before and after nephrectomy by International Index of Erectile Function, version 5 (IIEF-5). A subanalysis was performed by splitting the total cohort into 2 age groups: those <40 years of age (group 1, n = 21) and those >or=40 years of age (group 2, n = 73)., Results: Before and after nephrectomy, the prevalence of ED in group 1 was 9.5% and 19.0% respectively, and in group 2 was 38.4% and 56.2%. The difference between groups was statistically significant at the stage of preoperation (9.5% vs 38.4%, P = .012) and 12 months postoperation (19.0% vs 56.2% P = .003). Compared with the stage of preoperation, the prevalence of ED at the stage of postoperation was significantly increased at group 2 (38.4% vs 56.2%, P = .031), but not in group 1 (9.5% vs 19.0%, P = .663)., Conclusions: The prevalence of ED increased in living donors aged more than 40 years after nephrectomy in China. The change in sexual function of these living donors after nephrectomy should cause clinicians' attention., (Copyright 2010 Elsevier Inc. All rights reserved.)

Erectile dysfunction (ED), smoking, and alcohol drinking are common in middle-aged men. Although smoking has been shown to be a risk factor of ED in Chinese and other populations, the relationship between drinking alcohol and ED is not clear. The Family Planning Association of Hong Kong conducted the Men Health Survey in 2004. In all, 1506 men aged 20-70 years were recruited by stratified random sampling of the male population. Face-to-face interviews were used to collect information on drinking and smoking and other life style factors, morbidities, and sociodemographic status during household visits. The more sensitive information on sexual activity and ED was obtained by a self-completed questionnaire at the end of the interview. A total of 816 subjects aged 31-60 years currently active in sexual activity were included in the present analysis. Compared with never drinkers, alcohol drinkers who consumed three or more standard drinks (one standard drink equals 12 g of alcohol) a week were more likely to report EDs as defined by having both sexual dissatisfaction and erectile difficulty (odds ratio (OR)=2.27, 95% confidence interval (CI)=1.28-4.03) after adjusting for age and cigarette smoking. When analyzed separately by smoking habit, the risks were higher in current smokers (OR=2.27, 95% CI=1.01-5.11) than never smokers (OR=1.91, 95% CI=0.68-5.35). Our results suggest that alcohol drinking of three or more standard drinks per week might reduce sexual satisfaction and impair erectile function in current smokers and might have less effect in never smokers.

Objective: To assess the mean age of sexual activity termination, the prevalence of erectile dysfunction (ED), and their related factors in the old male population in Beijing., Methods: We included in this study 764 males aged over 60 years old received in the health examination clinic and investigated the prevalence of ED and the related factors using the sexual health assessment resource (SHARE) and IIEF-5 questionnaires., Results: The average age of sexual activity termination (no sexual intercourse in over 2 years) was 68.4 +/- 5.2 years among the subjects. The prevalence of ED was 89.4% , of which the rates of mild, moderate and severe ED and non-sexuality were 6.7, 18.6, 28.4 and 35.7% , respectively. Those who had no sexual intercourse for over 2 years because of severe ED accounted for 26.8% among the 60-64 years old males and more than 50% in the >70 yr group. The main risk factors for ED-induced sexual activity termination included age, diabetes, cardiovascular and cerebrovascular diseases, obesity, and low urinary tract symptoms (LUTS)., Conclusion: ED is a common problem as well as the main risk factor for sexual activity termination, and age and general health status are significantly associated with the prevalence of ED among aging males.

Objective: To investigate the epidemiological changes of erectile dysfunction (ED) patients in the past five years., Methods: In 2003 and 2008, we conducted two questionnaire investigations on the epidemiological changes of ED outpatients in 11 Chinese cities in such aspects as age, disease course, ED severity, smoking and drinking habits, accompanying hypertension, diabetes and coronary heart disease (CHD), and sexual intercourse satisfaction., Results: According to the valid copies of the questionnaire collected (808 in 2003 and 858 in 2008), the age pattern of the ED patients hardly changed in the past five years, over 60% aged 30 - 50 years. Compared with the results obtained in 2003, the second investigation showed obvious increases in the following numbers of the ED patients: by 13% in those with longer disease courses (5 - 10 yr), from 24.1 to 42.9% in those with moderate ED, from 20.4 to 29.9% in those with severe ED, by at least 10% in those with smoking and drinking habits, from 11.5 to 16.2% in those with hypertension, from 9.4 to 13.5% in those with diabetes, and from 57.6 to 73.3% in those without sexual satisfaction, while the number of those with CHD did not change significantly., Conclusion: Increased unhealthy living habits and erectile function impairing diseases have added to the incidence and severity of ED. There is still much work to be done in the prevention and early treatment of ED.

Objective: To investigate the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men aged > or = 50 years and to achieve the correlation between LUTS (obstructive symptoms and stimulant symptoms) and ED., Methods: We investigated 245 men aged > or = 50 years and with regular sex mates using International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), designed diagnostic interrogation and medical examination, and statistically analyzed the results of IPSS, IIEF-5, LUTS and their correlation with erectile function., Results: The incidence of ED was 81.9% (140/171) among the men with LUTS, 73.1% (38/52), 82.1% (46/56) and 88.9% (56/63) respectively in the 50-59, 60-69 and > or = 70 age groups, with significant differences in IPSS, IIEF-5 (P < 0.01) and the severity of ED (P < 0.01) among different age groups. ED incidence was found significantly correlated with the severity of LUTS (r = 0.52, P < 0.01), 71.3% (57/80), 89.6% (60/67) and 95.8% (23/24) respectively in the groups of mild, moderate and severe LUTS. The mean scores on obstructive and stimulant symptoms were (3.1 +/- 3.6) and (6.8 +/- 4.9), and their correlation coefficients with IIEF-5 were r = -0.41 (P < 0.01) and r = -0.59 (P < 0.01), respectively., Conclusion: The incidence of ED is high in men with LUTS and positively correlated with the severity of LUTS. Stimulant symptoms have greater influence than obstructive symptoms on the sexual life of old and middle-aged males.

Introduction: There have been limited multiregional studies in Asia examining the parameters of men's general and sexual health and quality of life in the general population vs. those in clinical cohorts of patients with erectile dysfunction (ED)., Aims: The aims of the Asian Men's Attitudes to Life Events and Sexuality (Asian MALES) study were to investigate the prevalence of ED, associated health conditions, and ED treatment-seeking patterns in the general male population in five regions of Asia (China, Japan, Korea, Malaysia, and Taiwan)., Main Outcome Measure: Standardized questionnaire previously used in a similar multiregional study and modified to ensure culturally appropriate content for Asia., Methods: Phase I of the study involved 10,934 adult men, aged 20-75 years, who were interviewed using the standardized questionnaire. Phase II of the study involved men with self-reported ED recruited from Phase I and via physician referral, invitations in general practitioner offices, and street interception (total Phase II sample, N = 1,209)., Results: The overall prevalence of self-reported ED in the Phase I study population was 6.4%. ED prevalence varied by region and significantly increased with age (P < 0.01). Men with ED reported significantly greater rates of comorbid illness (P < 0.0001) and a reduced quality of life (P = 0.0001), compared with men without ED. Phase II of the study revealed that fewer than half of men with self-reported ED had sought treatment for their problem. Men were more likely to seek help for erection difficulties from Western doctors than from traditional medicine practitioners (P = 0.0001). A man's partner/spouse was the most common influencer of treatment seeking in all regions except Malaysia., Conclusion: The findings confirm those of existing research on ED in both Asian and non-Asian males: ED is a prevalent condition; the prevalence of ED increases with age and is strongly associated with comorbid conditions; and the majority of men have never sought treatment for their condition. This study highlights a substantial need for the evaluation and treatment of ED in Asian men.

The authors examined the association between cigarette smoking and risk of erectile dysfunction among 7,684 Chinese men aged 35-74 years without clinical vascular disease. Cigarette smoking and erectile dysfunction were assessed by questionnaire. Vascular risk factors were measured according to standard methods. After adjustment for age, education, alcohol consumption, physical inactivity, diabetes, hypertension, overweight, and hypercholesterolemia, the odds ratio of erectile dysfunction was 1.41 (95% confidence interval (CI): 1.09, 1.81) for cigarette smokers compared with never smokers. There was a statistically significant dose-response relation between cigarette smoking and risk of erectile dysfunction (p(trend) = 0.005). Multivariate-adjusted odds ratios of erectile dysfunction were 1.27 (95% CI: 0.91, 1.77), 1.45 (95% CI: 1.08, 1.95), and 1.65 (95% CI: 1.08, 2.50) for those who smoked 1-10, 11-20, and more than 20 cigarettes per day, respectively, compared with never smokers. The association was stronger in participants with diabetes (odds ratio = 3.29, 95% CI: 1.49, 7.27) than in participants without diabetes (odds ratio = 1.33, 95% CI: 1.03, 1.73). If the association is causal, an estimated 22.7% of erectile dysfunction cases (11.8 million cases) among Chinese men are attributable to cigarette smoking. This 2000-2001 study of Chinese men documented an independent and dose-response relation between cigarette smoking and risk of erectile dysfunction.