Erectile Dysfunction Medication Use Research Articles

Beyond the prescription: trends and challenges in erectile dysfunction medications among young adult men.

We sought to assess erectile dysfunction (ED) medication use among males aged 18-40. Between June and July 2023, a cross-sectional survey on Qualtrics (Provo, UT) was disseminated via Research Match. Among 210 respondents, ED prevalence was 57.1% with 39.0% reporting prior ED medication use. Black or African American race (OR = 3.54, p < 0.001), Hispanic or Latino ethnicity (OR = 3.32, p = 0.01), and Medicare or Medicaid insurance status (OR = 6.07, p < 0.001) were associated with increased medication utilization. Income >$200,000 was associated with decreased medication usage (OR 0.23, p = 0.04). ED severity significantly correlated with higher medication usage. Primary care providers were the most common source of acquisition (47.6%), followed by online direct to consumer (DTC) platforms (31.7%) and personal connections (19.5%). Privacy (n = 51, 62.2%) and cost (n = 45, 54.9%) were key considerations in obtaining medications. Despite 73.2% of individuals receiving counseling regarding risks/benefits and 84.1% receiving instructions for proper use, only 28.0% correctly identified essential aspects of proper/appropriate use. Overall, we found a high ED prevalence and medication utilization rate. The preference for privacy in procuring medications suggests ongoing stigma around men's sexual health. Despite extensive counseling, a significant knowledge gap remains indicating a pressing need for enhanced patient education.

(161) Usage Patterns of Erectile Dysfunction Medications in Young Adult Men

Abstract Introduction There has been a significant increase in the accessibility of pharmacologic erectile dysfunction (ED) treatments through direct-to-consumer platforms. However, the impact of this broad accessibility on usage in young adult men has not been studied. Objective We sought to assess demographic, socioeconomic, and health factors associated with erectile dysfunction medication use among men aged 18-40 years. Methods We created a survey assessing prior phosphodiesterase-5 inhibitor (PDE-5) use, means of acquisition, and receipt of counseling prior to use. The survey was disseminated with the modified International Index of Erectile Function (IIEF-5) questionnaire to a convenience sample of men ages 18-40 via Research Match, an NIH-funded database of research participants. Demographic data including age, race, ethnicity, education level, insurance status, sexual orientation, and relationship status were collected. Descriptive statistics were performed using t-test, chi-squared test, and univariable and multivariable logistic regression with significance defined as p&amp;lt;0.05. Results Among 210 respondents, 82 (39.0%) indicated prior use of ED medication. Men identifying as Black or African American (OR = 3.54, 95% CI: 1.82-6.88, p&amp;lt;0.001) and Hispanic or Latino (3.32, 95% CI: 1.45-7.62, p=0.01) were more likely to have reported prior use. Higher rates of utilization were similarly observed among men insured by Medicare or Medicaid (OR = 6.07, 95% CI: 3.10-11.87, p&amp;lt;0.001). Income &amp;gt;$200,000 per year was associated with decreased utilization (OR 0.23, 95% CI: 0.06-0.92, p=0.04). Mild, mild to moderate, and severe erectile dysfunction per the modified IIEF scale were associated with increased utilization (OR = 3.09, 13.70, 20.25 and p-values = 0.01, &amp;lt;0.001, &amp;lt;0.001, respectively). There were no statistically significant differences among usage patterns with respect to age, education level, relationship status, or sexual orientation. Medicare or Medicaid coverage (p&amp;lt;0.001) and IIEF symptom severity were significant independent predictors on multivariable regression. Performance anxiety with a partner (56.6%), difficulty maintaining erections (46.9%), and providing confidence during intercourse (39.5%) were the most frequently cited reasons behind use. Primary care providers were the most frequent source of initial procurement (30.9%), followed by friends, family members, or partners (25.9%) and direct-to-consumer online platforms (18.5%). The most important factors considered in procuring medications were privacy (61.7%) and cost (54.3%). Despite 72.8% of men reporting counseling on proper use and risks, only 28.0% were able to correctly identify four key features surrounding proper use (including medication timing, dosage interval, prolonged erections, and sexual stimulation requirement). Conclusions We found high use of ED medication among young adult men, particularly among those identifying as Black or African American and Hispanic or Latino, as well as those insured by Medicare or Medicaid. The emphasis on privacy over cost and convenience in obtaining medications likely demonstrates continued stigma surrounding men’s health and sexual health issues. Despite most men reporting counseling on proper use, a stark knowledge gap exists as only a minority of men can correctly identify proper use. This underscores the need for healthcare professionals to provide thorough patient education and guidance to ensure safe and effective use of these medications in young men. Disclosure No.

Erectile Dysfunction Pharmacotherapy Utilization after 60Gy in 20 Fractions Volumetric Modulated Arc Therapy to the Prostate

To determine which factors predict for worsening erectile function after highly conformal, modestly hypofractionated radiotherapy to the prostate. All patients who received 60Gy in 20 fractions, volumetric modulated arc therapy to the prostate across 4 centers over 9 years were included in this study. The provincial electronic medical record was interrogated to identify any new prescriptions for erectile dysfunction (ED) medication, any change in prescription of ED medication or any permanent discontinuance of ED medication persisting beyond 6 months post completion of any androgen deprivation therapy. The penile bulb, penile crux and penile shaft structures were retrospectively contoured. A Youden receiver-operator-curve analysis, logistic regression, and neural network based interpretable machine learning analysis were then used to determine dependencies between worsening ED and clinical factors including mean doses to these structures. Two-hundred-twelve patients with median (inter-quartile-range) follow-up of 3.6 (3.2-4.4) years were identified. Median age was 72 (67-76) years. 104 (49%) patients received androgen deprivation therapy. Prior to treatment, 52 (25%) patients were on ED medication: 20 (9%) on sildenafil, 28 (13%) on tadalafil and 4 (8%) on vardenafil. Median PTV volume was 158.9 (129.8-192.1) cc. Median penile bulb, penile crux and penile shaft volumes were 4.7 (3.6-6.2) cc, 6.5 (5.1-8.5) cc and 93.3 (80.6-106.2) cc, respectively. PTV V95 was 99.8 (99.5-99.9)%. Mean doses to penile bulb, penile crux and penile shaft were 2094.8 (1306.2-3036.3) cGy, 2094.8 (1306.2-3036.3) cGy and 444.4 (313.2-650.5), respectively. Fifty-nine (28%) patients had a worsening of ED after treatment: 25 (12%) started a new ED medication, 6 (3%) had a prescription change and 28 (13%) stopped ED medication. On univariate analyses pretreatment use of ED medication predicted for worsening ED: odds ratio (OR) yes vs no: 10.2 (5.0 - 20.8; p<0.001). A trend towards mean dose to penile bulb [OR ≤2343.9 vs >2343.9: 1.7 (0.9-3.2; p = 0.08)] predicting for worsening ED was observed. Mean doses to penile crux [OR <1725.8 vs > 1725.8: 2.6 (1.3-5.2; p = 0.005)] and penile shaft [OR ≤344.9 vs >344.9: 5.2 (2.2-12.2; p<0.001)] predicted for worsening ED. Use of androgen deprivation therapy, and age at time of radiotherapy were not predictive of worsening ED. On multivariate analysis, only mean dose to penile shaft [OR ≤344.9 vs >344.9: 6.3 (1.9-20.3; p = 0.002)] and pretreatment use of ED medication [OR yes vs no: 11.1 (5.3-23.2; p<0.001)] predicted for worsening ED. A neural network analysis suggested that penile shaft mean dose and pre-treatment ED medication use are the most important factors in predicting worsening ED. In this limited analysis, pre-treatment use of ED medication and mean dose to penile shaft predicted for worsening ED after treatment with modestly hypofractionated radiotherapy for prostate cancer.

Predicting Erectile Dysfunction after Highly Conformal, Hypofractionated Radiotherapy to the Prostate

Background: Erectile dysfunction (ED) is common after prostate cancer treatment. It has been studied for conventional radiotherapy, but associations in the hypofractionated radiotherapy context are less clear. This study aimed to determine which factors are predicted for worsening ED after highly conformal, modestly hypofractionated radiotherapy to the prostate. Methods: Two hundred and twelve patients treated with 6000 cGy in twenty fractions across four centers were included in this study. Demographic, clinical, and dosimetry factors were then evaluated for post-treatment declines in erectile function using logistic regression and an explainable machine learning-based neural network. Results: 212 patients with a median follow-up of 3.6 years were evaluated. A total of 104 (49%) patients received androgen deprivation therapy. Prior to treatment, 52 (25%) patients were on ED medication. Mean doses to the penile bulb, penile crus, and penile shaft were 2490 (IQR: 1529–3656) cGy, 2095 (1306–3036) cGy, and 444 (313–650) cGy, respectively. Fifty-nine (28%) patients had a worsening of ED after treatment. On multivariable analysis, only the mean dose to the penile shaft [OR &gt;345 vs. ≤345: 4.47 (1.43–13.99); p = 0.010] and pretreatment use of ED medication [OR yes vs. no: 12.5 (5.7–27.5; p &lt; 0.001)] predicted for worsening ED. The neural network confirmed that the penile shaft mean dose and pre-treatment ED medication use are the most important factors in predicting ED. Conclusions: Pre-treatment ED and penile shaft dosimetry are important predictors for ED after hypofractionated radiotherapy for prostate cancer.

Recreational use of oral erectile dysfunction medications among male physicians - A cross-sectional study.

Erectile dysfunction (ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Bypassing health-care providers and obtaining ED medications (EDM) without a prescription are an issue that is faced globally. We attempt to assess erectile function (EF) among a local sample of physicians, the psychological effects of recreational EDM use, and compare EF among different user groups. This is a cross-sectional study done solely on physicians in Saudi Arabia. A self-designed questionnaire including demographics, sexual characteristics, use of ED medication, sexual satisfaction, and the validated international index of EF (IIEF). Physicians misused EDM. A total of 503 physicians completed the questionnaire. Among participants reporting sexual problems, only 23% received counseling and 3.4% were professionally diagnosed with ED. Among users, 71.2% were using EDM recreationally, 14.4% prophylactically, and 14.4% were prescribed. Participants aged 20-29 IIEF-5 score was significantly lower than participants aged 30-39 years. Prescribed users had a lower IIEF-5 score compared to both recreational users and nonusers. Many healthy sexually active men use EDMs recreationally to increase sexual performance. One of the limitations of our study is that we did not use standardized tools to determine the diagnosis of some important disorders like premature ejaculation. Our study strengths include the very high response rate, with our results truly showing a nationwide self-assessment of sexual dysfunction. Recreational use of oral EDMs may adversely impact the psychological aspects of sexual function. In our study, physicians misused EDM. We recommend labeling EDMs as restricted medication that requires a prescription to use by a licensed physician.

V10-08 THE USE OF FOCAL IRREVERSIBLE ELECTROPORATION FOR PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023V10-08 THE USE OF FOCAL IRREVERSIBLE ELECTROPORATION FOR PROSTATE CANCER John Torosyan, Amy Cherry, Hasan Abbas, Shima Tayebi, and Abhinav Sidana John TorosyanJohn Torosyan More articles by this author , Amy CherryAmy Cherry More articles by this author , Hasan AbbasHasan Abbas More articles by this author , Shima TayebiShima Tayebi More articles by this author , and Abhinav SidanaAbhinav Sidana More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy of prostate cancer is a treatment strategy that aims to destroy the cancer-containing parts of the prostate while preserving uninvolved prostatic tissue in an attempt to preserve genitourinary function. Irreversible Electroporation (IRE) is a novel ablative modality which utilizes electrical pulses to induce cell apoptosis and can be applied to various malignancies, including prostate cancer. The objective of this video is to discuss the mechanism of action of IRE and describe the components, setup, and operative technique for performing IRE for the focal treatment of prostate cancer. METHODS: IRE is performed under general anesthesia with the patient placed in lithotomy position. Monopolar electrodes are inserted into the prostate under ultrasound guidance and using a brachytherapy grid. The probes are placed 1.5 to 2cm away from one another, and 3-5mm away from the prostatic capsule using cognitive fusion to cover the lesion and 5-10mm margin. After initially estimating voltage configurations, ten test impulses are fired between each probe pair to assess resulting currents. Using test results, final voltages are assigned, and the remaining 80 impulses are fired between each probe pair. RESULTS: This case involves a 74-year-old male with a history of hypertension and hyperlipidemia who presented with an elevated Prostate-Specific Antigen (PSA) of 6.35 and was found to have Gleason 3+4 cancer in the Prostate Imaging Reporting & Data System (PI-RADS) 4 lesion localized in the right mid gland to apex. The patient had a pre-treatment International Prostate Symptom Score (IPSS) of 4-1 and a Sexual Health Inventory for Men (SHIM) of 18 without the use of erectile dysfunction medication. The patient underwent a successful IRE ablation of the lesion along with the margin. The procedure was tolerated well, and the patient was discharged later that day. At his 6-week follow-up, PSA declined to 0.66 and he had an unchanged IPSS/SHIM. CONCLUSIONS: The use of focal therapy in prostate cancer is promising because of its effectiveness paired with minimal procedural side effects. Focal IRE provides a safe and effective way to achieve focal therapy of prostate cancer. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e928 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Torosyan More articles by this author Amy Cherry More articles by this author Hasan Abbas More articles by this author Shima Tayebi More articles by this author Abhinav Sidana More articles by this author Expand All Advertisement PDF downloadLoading ...

PD26-08 ERECTILE DYSFUNCTION IN MEN WITH PREDIABETES AND TYPE 2 DIABETES: THE DIABETES PREVENTION PROGRAM OUTCOMES STUDY (DPPOS)

You have accessJournal of UrologyCME1 Apr 2023PD26-08 ERECTILE DYSFUNCTION IN MEN WITH PREDIABETES AND TYPE 2 DIABETES: THE DIABETES PREVENTION PROGRAM OUTCOMES STUDY (DPPOS) Yooni Blair, Lindsay Doherty, Marinella Temprosa, Hunter Wessells, Rodica Pop-Busui, Kishore Gadde, Prachi Singh, Aruna V. Sarma, and DPP Research Group Yooni BlairYooni Blair More articles by this author , Lindsay DohertyLindsay Doherty More articles by this author , Marinella TemprosaMarinella Temprosa More articles by this author , Hunter WessellsHunter Wessells More articles by this author , Rodica Pop-BusuiRodica Pop-Busui More articles by this author , Kishore GaddeKishore Gadde More articles by this author , Prachi SinghPrachi Singh More articles by this author , Aruna V. SarmaAruna V. Sarma More articles by this author , and DPP Research Group More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) is more common and less responsive to pharmacotherapy in men with T2D. Data in men with prediabetes (PreD) and risk profiles in those with T2D, are lacking. We determined the burden and risk factors for ED in men with PreD and with T2D enrolled in the DPPOS. METHODS: Between 1996-1999, 3,234 adults with PreD were randomized to intensive lifestyle intervention, metformin, or placebo in the DPP. In 2001, metformin was continued for those originally randomized with modified lifestyle intervention offered to all. In 2016-2017, 568 (88%) of 648 male participants completed the International Index of Erectile Function (IIEF). ED was defined as having low or very low confidence getting and keeping an erection and/or ED medication use. Backwards selection multivariable logistic regression models including DPP treatment estimated odds of ED for covariates significant in bivariate analysis in men with persistent PreD and T2D. RESULTS: Overall, 218 (38%) men met ED criteria. Prevalence of ED was similar in men with PreD (41%) and T2D (37%) (p=0.4). In all men, older age (p<0.001), non-white race (p<0.001) and depression (defined by Beck Depression Inventory or antidepressant use) (p<0.01) were associated with ED. Among men with PreD, those assigned to intensive lifestyle intervention, but not metformin, had decreased odds of ED compared with the placebo group (OR=0.26, 95% CI=0.09, 0.77). Among men with T2D, metabolic syndrome (MetS), defined by NCEP ATP III criteria, was associated with increased odds of ED (OR=1.72, 95% CI=1.05, 2.83). CONCLUSIONS: ED is highly prevalent in men with PreD and with T2D. In addition to demonstrated factors typically observed in the general population such as younger age and absence of depression, intensive lifestyle intervention was protective in men at increased risk for T2D. In men with T2D, ED was associated with MetS. Our findings suggest metabolic mechanisms contribute to the pathogenesis of ED in T2D. Source of Funding: National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, and UDK048400) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e738 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yooni Blair More articles by this author Lindsay Doherty More articles by this author Marinella Temprosa More articles by this author Hunter Wessells More articles by this author Rodica Pop-Busui More articles by this author Kishore Gadde More articles by this author Prachi Singh More articles by this author Aruna V. Sarma More articles by this author DPP Research Group More articles by this author Expand All Advertisement PDF downloadLoading ...

86-OR: Erectile Dysfunction in Men with Prediabetes and Type 2 Diabetes: The Diabetes Prevention Program Outcomes Study (DPPOS)

Introduction: Erectile dysfunction (ED) is more common and less responsive to pharmacotherapy in men with T2D. Data in men with prediabetes (PreD) and risk profiles in those with T2D, are lacking. We determined the burden and risk factors for ED in men with PreD and with T2D enrolled in the DPPOS. Methods: Between 1996-1999, 3,234 adults with PreD were randomized to intensive lifestyle intervention, metformin, or placebo in the DPP. In 2001, metformin was continued for those originally randomized with modified lifestyle intervention offered to all. In 2016-2017, 568 (88%) of 648 male participants completed the International Index of Erectile Function (IIEF) . ED was defined as having low or very low confidence getting and keeping an erection and/or ED medication use. Backwards selection multivariable logistic regression models including DPP treatment estimated odds of ED for covariates significant in bivariate analysis in men with persistent PreD and T2D. Results: Overall, 218 (38%) men met ED criteria. Prevalence of ED was similar in men with PreD (41%) and T2D (37%) (p=0.4) . In all men, older age (p&amp;lt;0.001) , non-white race (p&amp;lt;0.001) and depression (defined by Beck Depression Inventory or antidepressant use) (p&amp;lt;0.01) were associated with ED. Among men with PreD, those assigned to intensive lifestyle intervention, but not metformin, had decreased odds of ED compared with the placebo group (OR=0.26, 95%CI=0.09, 0.77) . Among men with T2D, metabolic syndrome (MetS) , defined by NCEP ATP III criteria, was associated with increased odds of ED (OR=1.72, 95%CI=1.05, 2.83) . Conclusions: ED is highly prevalent in men with PreD and with T2D. In addition to demonstrated factors typically observed in the general population such as younger age and absence of depression, intensive lifestyle intervention was protective in men at increased risk for T2D. In men with T2D, ED was associated with MetS. Our findings suggest metabolic mechanisms contribute to the pathogenesis of ED in T2D. Disclosure Y.Blair: None. L.Doherty: None. M.Temprosa: None. H.Wessells: None. R.Pop-busui: Advisory Panel; Averitas Pharma, Inc., Boehringer Ingelheim International GmbH, Nevro Corp., Novo Nordisk, Reata Pharmaceuticals, Inc., Regenacy Pharmaceuticals, Inc. K.M.Gadde: Research Support; AstraZeneca, BioKier, Inc. P.Singh: None. A.V.Sarma: None. D.Research group: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, and UDK048400)

Victims of virility: Honor endorsement, stigma, and men’s use of erectile dysfunction medication.

Victims of virility: Honor endorsement, stigma, and men’s use of erectile dysfunction medication.

Staying or moving: Results of a latent transition analysis examining intra-individual stability of recreational substance use among MSM in the Multicenter AIDS Cohort Study from 2004 to 2016

BackgroundStudies have examined patterns of substance use among Men who have Sex with Men (MSM), but few have examined factors predicting transitioning from one substance use pattern to another. We investigated transitioning from one substance use pattern to another over a 12-year period (2004–2016) among the Multicenter AIDS Cohort Study participants. MethodAlcohol, marijuana, heroin, cocaine, poppers, uppers (e.g., methamphetamines) and erectile dysfunction(ED) medications use in the last 6 months from 3568 US MSM was dichotomized (no/yes) to classify participants into substance use classes at each follow up visit. We fit latent transition models to calculate transition probabilities of moving from one substance use class to another over a 3, 4 and 6-year time period. Then fit regression models to identify factors associated with the probability of each participant staying in or moving from the same substance use class. ResultsOverall, cocaine and ED medication use declined but marijuana and heroin use increased over 2004−2016. We observed most participants (84.6 %–100 %) stayed in the same class. Increased age was associated with transition from the Minimal-use class to the Alcohol-only class (aOR = 1.06,95 %CI:1.01−1.13;p < 0.01) and non-White MSM reported lower odds of moving from the Alcohol-only class to the Alcohol-Popper class (aOR = 0.50,95 %CI:0.30−0.82;p <0.01). There were no difference in the transition probabilities by HIV-status. ConclusionDespite decline in substance use in general, participants are highly stable in their choice of substances. However, treating MSM as a homogeneous group can lead to an under-appreciation of the diversity of prevention needs and treatment of substance using MSM.

Factors associated with use of sexual enhancers and erectile dysfunction medications among male undergraduates aged 18-35yrs at Jomo Kenyatta University of Agriculture and Technology, Kenya

Background: Oral erectile dysfunction medications and sexual enhancers have been increasingly abused among young men without a medical indication. Recreational use of erectile dysfunction medication (EDMs) and sexual enhancers is associated with risky sexual behaviour and substance use. In recognition of the sexual health challenges facing the youth, this study sought to establish the level of utilization of sexual enhancers and EDMs and factors associated with their use among the youth in JKUAT. Methods: A concurrent nested design was be used. It adopted a cross-sectional quantitative study design (through self-administered questionnaires) and a concurrent qualitative study (through Focus Group Discussions). Simple random sampling was used to obtain the required study participants for both quantitative data (420 respondents) and qualitative data (48 respondents). Results: Among the 420 respondents (age, 21.7 ±2.03years), 82.9% (n=348) had heard about EDMs and/or sexual enhancers but only10 % (n=42) has used them. There was a significant relationship between EDM and/or sexual enhancers use and age (P&lt;0.001), religion (P=0.013), number of sexual partners (P=0.027), number of ‘one-night’ stands (P=0.003), and use of condom or knowledge of partner’s status before intercourse (P=0.011). Conclusion: The prevalence of EDMs and/or sexual enhancer use among the students was 10%. Risky sexual behaviour and substance abuse including alcohol consumption was associated with EDMs and/or sexual enhancers’ use. The university social environment influenced the sexual risk behaviours. Continuous awareness campaigns aimed at educating undergraduate students about the risks involved in the recreational use of EDMs and/or sexual enhancers should be done.

Overall Mental Health and Misuse of Erectile Dysfunction Medication Among Sexual Minority Men

Background: Research has noted that rates of recreational use of erectile dysfunction medication (EDM) are particularly high among men who have sex with other men. Though previous research has investigated recreational EDM use in relation to substance use, its association with other general mental health symptoms and diagnoses remains unexamined. Objectives: To address the paucity of research on EDM misuse, the current study examined prevalence rates of EDM misuse among sexual minority men and its association with last 12-month and 30-day mental health symptoms and diagnoses. Method: A secondary analysis of 7,658 sexual minority undergraduate and graduate male students recruited as part of the American College of Health Association’s National College Health Assessment was performed. Results: Results indicated that 2.2% of sexual minority men reported misuse of EDMs within the last 12 months. Last 12-month EDM misuse was significantly associated with a number of mental health symptoms and diagnoses in the last 12 months and last 30 days. Most notably, small to moderate effects were found for misuse of other prescribed medications, such as antidepressants, painkillers, and sedatives, and diagnosis of substance use within the last 12 months. Small effects were found for sedatives and steroid misuse in the last 30 days. Conclusion: Results suggest that worse mental health, particularly substance use, is associated with EDM misuse among sexual minority men. As such, further research in this area is needed.

Degree of Planning of Sexual Intercourse Among Men From China, Japan, and Taiwan Taking Medication for Erectile Dysfunction: Findings of an Observational, Cross-Sectional Survey.

IntroductionManagement of erectile dysfunction (ED) is beset with assumptions around spontaneity of sexual intercourse, requiring candor between the physician and patient if appropriate treatment is to be implemented.AimTo evaluate the degree to which men who take ED medications plan for and have sex.MethodsMen from China, Japan, and Taiwan aged 40–70 years who had taken ED medications within the past 3 months were invited to participate anonymously in an online, self-administered survey that enquired about frequency and advance planning of sex, time between taking ED medication and intercourse, and treatment satisfaction. Data were analyzed using descriptive statistics.Main Outcome MeasureFrequency of planning of sexual intercourse, planning and ED medication dosing interval, and frequency of ED medication use.ResultsData from 604 respondents (mean age 50.8 years) from China (n = 254), Japan (n = 250), and Taiwan (n = 100) were collected. Men used ED medications a median of ≤4 times per month in all 3 territories. 76% who used ED medication during the past 3 months planned for sex on specific occasions, with 59% and 52% agreeing that they plan for sex on specific days of the week and times of the day, respectively. Most commonly, men planned for sex up to several hours to a day beforehand, with 94% taking ED medication within 4 hours of sex. Satisfaction with ED medication was generally high and related to erection rigidity, speed of onset, and safety.ConclusionKnowledge of the degree to which individuals with ED plan for sex may have important implications for the appropriate prescription of ED medication. The high degree of planning around sexual activities exhibited by men taking ED medication suggests there is a need for appropriate counseling to ensure that treatment is aligned with patient behavior.Jiann B-P, Nakajima K, Dighe S, et al. Degree of planning of sexual intercourse among men from China, Japan, and Taiwan taking medication for erectile dysfunction: Findings of an observational, cross-sectional survey. Sex Med 2019;7:54–60.

Sexual habits of men with ED who take phosphodiesterase 5 inhibitors: a survey conducted in 7 countries.

Western cultural perceptions that favour spontaneous sex may create unrealistic expectations for erectile dysfunction (ED) treatment. Little is known about how users of phosphodiesterase type 5 inhibitors (PDE5Is) plan sexual activity and timing of their preactivity PDE5I ingestion. Because various PDE5Is vary in their duration of action and dosage regimen, this may be an important consideration in selecting the optimal agent for the ED patient. To better understand the sexual habits of PDE5I users. Men from 7 countries (Brazil, China, Italy, Japan, Russia, Taiwan, Turkey) were screened online for age, self-reported comorbidities and ED medication use in the prior 3months. After screening, eligible participants were asked to complete a 7-question, self-administered online survey containing questions regarding sexual habits and behaviours. Survey questions focused primarily on advanced planning of sexual intercourse and timing of PDE5I ingestion but also addressed the frequency of sexual intercourse and ED medication use. Of the 1458 respondents (response rate: 48%; median age: 48years [interquartile range (IQR), 44-55]), 83% always/sometimes planned a specific time for intercourse in advance; 72% planned a specific time for sexual intercourse up to several hours in advance. Of respondents who planned in advance, more than half planned specific days of the week (55%) and times of the day (60%) for sexual intercourse. The time to sexual intercourse after dosing was ≤1hour for 70% and ≤4hours for 96% of men. The median frequency of sexual intercourse was 6 times/month (IQR, 4-10), with ED medication taken a median of 5 times/month (IQR, 3-8). Sexual activity is usually planned by ED medication users several hours in advance, and the vast majority are attempting activity within a short time after ingestion of the agent. These data should aid clinicians in the selection of the optimal PDE5I.

Sociodemographic patterns in pharmacy dispensing of medications for erectile dysfunction in Sweden

PurposeThe purpose of this study is to investigate the relationship between sociodemographic factors and pharmacy dispensing of medications for erectile dysfunction (ED) in the general population of middle-aged and elderly men. By considering a number of medical conditions that could promote or contraindicate use of ED medication, the analysis could help capture prescription patterns that might not be explained by medical needs.MethodsIndividual-level pharmacy dispensing data from 2006 for a population-based cohort of 216,148 men aged 45–79 years in the county Scania, Sweden, were analysed. Multiple logistic regression was applied, and area under the receiver operating characteristic curve (AUC) was calculated to quantify the discriminatory accuracy (DA) of the associations. National trends in pharmacy dispensing of ED medication between 2006 and 2016 were also analysed.ResultsPharmacy dispensing of ED medication increased between 2006 and 2016, particularly among men aged 65–79 years (from 6.8 to 9.2%). Dispensing of ED medication was positively associated with higher socioeconomic position, and divorced and widowed men were more likely to fill a prescription with ED medication than married men. These associations remained after adjusting for medical conditions. The DA of the associations was, however, rather low (AUC = 0.69 among 45–64 year olds and AUC = 0.65 among 65–79 year olds).ConclusionsPharmacy dispensing of ED medication seem linked to the individuals socioeconomic position, age and marital status suggesting sociodemographic disparities in the pharmacy dispensing targeting sexual function. However, the low DA of the associations shows the limited capacity of these factors to predict ED medication use at the individual level.

Off-Label Use of Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia

Off-Label Use of Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia

Prevalence of use of erectile dysfunction medication by Dutch military personnel between 2003 and 2012.

Use of ED medication can be seen as a marker for ED. ED is associated with increasing age, exposure to traumatic events and physical injuries in military veterans. The objective of this study was to assess the prevalence of use of ED medication in Dutch military personnel in the period 2003-2012 and to assess its association with age and psychotropic medication use. Data on dispensing of ED medication, age and co-medication with psychotropic medication of all Dutch military personnel between 2003 and 2012 were collected. The prevalence of ED medication use in each year was estimated, stratified for age and use of psychotropic medication. The number of ED medication users increased a hundredfold from 0.09 to 9.29 per 1000 per year between 2003 and 2012. ED medication was more often used by men over 40 than under 40 (prevalence in 2012: 2.4% vs 0.2%, OR (2003-2012, adjusted for calendar year) 15.6, 95% CI 13.5-17.9) and by men using psychotropic medication (prevalence in 2012: 3.8% vs 0.9%, OR (2003-2012, adjusted for calendar year) 3.13, 95% CI 2.66-3.67). This study shows a strong increase between 2003 and 2012 in a number of ED medication users in male Dutch military personnel. ED medication use increases with age and with psychotropic medication use.

“Smoking pot helps me focus”: A qualitative analysis of Internet forum discussions of ADHD and cannabis use

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e153 Online feasibility study about HIV-negative male couples substance use with weekly ecological momentary diary assessments Jason W. Mitchell 1, Francesca Davis1, Yue Pan2, Daniel J. Feaster1 1 Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States 2 University of Miami Miller School of Medicine, Miami, FL, United States Aims: To date, little is known about male couples’ use of substances despite the role that substance use plays in HIV seroconversion among gay men. The aims of the present study were twofold: (1) to assess whether panel dyadic data could be collected from HIV-negative male couples about their substance use using online weekly ecological momentary diary assessments; (2) to examine couples’ rates of substance use and contexts of their usage. Methods: A longitudinal study design using ecological momentary weekly electronic diaries was used to examine male couples substance use with/out sex, and the contexts of their usage over a 6-week period. Targeted facebook ads were used to recruit the sample along with a partner referral system to invite eligible participants’ main partners. 531 men took the screener; of these, 97 were eligible, consented and enrolled in the study. Results:Although97partneredmenenrolled, only 13male couples with both partners and 15 male couples with one partner participated in the study. Over the 6-week period, men’s engagement inUASwith theirmain partner, alcohol consumption, and use of erectile dysfunction medication, prescription pain medication (PPM), and/or illicit drug(s) varied. Men frequently usedmarijuana and/or alcohol in a variety of contexts including sex. Among the 13 male couples, both partner’s use of illicit drugs includingmarijuana (ICC 0.97, P 5 posts for analysis. Results: Qualitative analysis of individual posts indicated that Internet discussionparticipants emphasized the therapeutic effects of cannabis for ADHD – fewer endorsed either a null or harmful impact. Exploratory analysis also indicated that participants perceived fewer concerns about cannabis due to it being “natural,” that cannabis is perceived to improve impairment in ADHD (e.g., driving), distrust of the medical community regarding stimulant medication efficacy, and a preference for particular cannabis strains. Conclusions: Cannabis use in the US is changing and there is a need for further research of how cannabis impacts at-risk groups, such as those with ADHD. This qualitative study provides new insight into currentlyheldperceptions about cannabisuse inADHD. We propose a number of novel hypotheses guided by qualitative analysis ofweb-forumcontent,which canguide future quantitative e154 Abstracts / Drug and Alcohol Dependence 156 (2015) e102–e182 studies. This study also illustrates the potential use of web-based data to study substance use. Financial support: NIDA (K23 DA032577). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.418 Sex differences in intrinsic connectivity during FMRI stroop in cocaine-dependent and healthy comparison subjects Marci R. Mitchell 1, Elise E. DeVito1, I. Balodis1, Cheryl Lacadie2, Dustin Scheinost3, R. Todd Constable2, Robert Malison1, Kathleen M. Carroll 1, Marc N. Potenza1 1 Psychiatry, Yale University School of Medicine, New Haven, CT, United States 2 Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, United States 3 Biomedical Engineering, Yale University School of Medicine, New Haven, CT, United States Aims: Previouslywe found cocaine-dependent (CD) versus control subjects (HC) showed greater mean-adjusted connectivity in the ventral striatum, putamen, inferior frontal gyrus, anterior insula, thalamusandsubstantianigra.However, theextent towhich womenandmen showeddifferences in functional connectivitywas not previously examined. This study investigated sex differences in intrinsic connectivity distribution (ICD) in CD subjects during fMRI Stroop performance. Methods: 38 current CD (19 female) and 38 matched HC subjects (19 female) completed an fMRI Stroop task. Mean-adjusted ICD analyses were conducted to identify sex differences. Results: Both increases and decreases in connectivity were observed in all four comparisons (Females CD–HC; Males CD–HC; CD Males–Females; HC Males–Females), and an interaction between gender and diagnostic group implicated connectivity differences in the orbitofrontal cortex (OFC), ventral striatum, precuneus/cuneus, cingulate gyrus, and occipital lobe. Out-of-scanner behavioral Stroop data did not reveal differences between males and females between diagnostic groups, but did show sex differences within the CD group but not the HC group. Conclusions: Differences in intrinsic connectivity involved the OFC, cingulate, and striatum, areas implicated in cocaine dependence and cognitive processes including decision-making and inhibitory control. Differences in regions associated with language and visual processing were also observed. The extent to which these patterns of connectivity relate to clinically relevant measures of cocainedependencewarrants additional investigation. Financial Support: ORWH, OD, NIDA (K12-DA031050, R01DA020908, R01-DA035058, P50-DA09241, R01-DA019039, P20DA027844). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.419 Counselors’ views of providing patient-centered methadone treatment in a clinical trial Shannon G. Mitchell 1, Laura Monico1, Elizabeth Lertch1, Jan Gryczynski1, Sharon M. Kelly1, K.E. O’Grady2, Jerome H. Jaffe1, Robert P. Schwartz1 1 Friends Research Institute, Baltimore, MD, United States 2 University of Maryland, College Park, MD, United

Online feasibility study about HIV-negative male couples substance use with weekly ecological momentary diary assessments

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e153 Online feasibility study about HIV-negative male couples substance use with weekly ecological momentary diary assessments Jason W. Mitchell 1, Francesca Davis1, Yue Pan2, Daniel J. Feaster1 1 Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States 2 University of Miami Miller School of Medicine, Miami, FL, United States Aims: To date, little is known about male couples’ use of substances despite the role that substance use plays in HIV seroconversion among gay men. The aims of the present study were twofold: (1) to assess whether panel dyadic data could be collected from HIV-negative male couples about their substance use using online weekly ecological momentary diary assessments; (2) to examine couples’ rates of substance use and contexts of their usage. Methods: A longitudinal study design using ecological momentary weekly electronic diaries was used to examine male couples substance use with/out sex, and the contexts of their usage over a 6-week period. Targeted facebook ads were used to recruit the sample along with a partner referral system to invite eligible participants’ main partners. 531 men took the screener; of these, 97 were eligible, consented and enrolled in the study. Results:Although97partneredmenenrolled, only 13male couples with both partners and 15 male couples with one partner participated in the study. Over the 6-week period, men’s engagement inUASwith theirmain partner, alcohol consumption, and use of erectile dysfunction medication, prescription pain medication (PPM), and/or illicit drug(s) varied. Men frequently usedmarijuana and/or alcohol in a variety of contexts including sex. Among the 13 male couples, both partner’s use of illicit drugs includingmarijuana (ICC 0.97, P 5 posts for analysis. Results: Qualitative analysis of individual posts indicated that Internet discussionparticipants emphasized the therapeutic effects of cannabis for ADHD – fewer endorsed either a null or harmful impact. Exploratory analysis also indicated that participants perceived fewer concerns about cannabis due to it being “natural,” that cannabis is perceived to improve impairment in ADHD (e.g., driving), distrust of the medical community regarding stimulant medication efficacy, and a preference for particular cannabis strains. Conclusions: Cannabis use in the US is changing and there is a need for further research of how cannabis impacts at-risk groups, such as those with ADHD. This qualitative study provides new insight into currentlyheldperceptions about cannabisuse inADHD. We propose a number of novel hypotheses guided by qualitative analysis ofweb-forumcontent,which canguide future quantitative

Differences in Gay Male Couples' Use of Drugs and Alcohol With Sex by Relationship HIV Status.

Prior studies with men who have sex with men have documented a strong association between substance use with sex and risk for acquisition of HIV. However, few studies have been conducted about gay male couples' use of substances with sex, despite the fact that between one third and two thirds of men who have sex with men acquire HIV from their relationship partners. The present study sought to (1) describe whether one or both partners in the male couple uses substances with sex-by substance type-within and/or outside of their relationship, and (2) assess whether differences exist in those who use substances with sex within and outside the relationship by the couples' HIV status. Dyadic data for this analysis were collected in the United States from a nation-wide cross-sectional Internet study about male couples' relationships and behaviors. Couple-level descriptive and comparative analyses were employed with 361 male couples. Except for alcohol, most couples did not use substances with sex. Of those who did, rates of who used it with sex and substance type within the relationship varied; most couples only had one partner who used substances with sex outside the relationship. Significantly higher proportions of concordantly HIV-negative and HIV-positive couples had both partners who used substances (all types) with sex within their relationship over discordant couples. Most couples had one partner who used outside the relationship; only marijuana and erectile dysfunction medication use with sex significantly differed by couples' HIV status. Findings indicate the need to conduct additional research for prevention development.