Erectile Dysfunction Medications Research Articles

Evaluation and management of nonarteritic anterior ischemic optic neuropathy: a national survey.

The evaluation and management of Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) lacks standardized guidelines. This study aimed to investigate the real-world practices of neuro-ophthalmologists in the evaluation and management of typical NAION cases. A national survey, conducted between 2019 and 2021, involved all practicing neuro-ophthalmologists. A structured questionnaire assessed their approach to risk factor evaluation and treatment of NAION, with 19 questions about risk factors and six questions concerning treatment and prevention of fellow-eye involvement. Thirty-six out of 37 neuro-ophthalmologists participated. Most physicians referred patients for evaluation of the following risk factors: obstructive sleep apnea (83.3%), diabetes mellitus (83.3%), hypertension (77.7%), dyslipidemia (72.2%), and optic disc drusen (38.8%). However, there was considerable variation in the choice of diagnostic tests recommended. Furthermore, nearly 47% recommended an embolism workup. Regarding treatment, the majority (91%) did not recommend routine treatment for NAION, although in 16.7%, high-dose corticosteroids were occasionally prescribed. Secondary prevention with aspirin (80.6%), smoking cessation advice (86.1%), and advising against erectile dysfunction medications for men (80.6%) were common recommendations. While the risk factors associated with NAION are well-reported, there is a lack of uniformity on which tests should be ordered to evaluate these risk factors. Most neuro-ophthalmologists concur that routine treatment for NAION is not warranted, but not unanimously. Future studies to develop a consensus guideline for post-NAION work-up and management recommendations may assist in the detection and management of preventable risk factors.

A Review on Risk Factors, Diagnostic Innovations, and Plant Based Therapies for the Management of Erectile Dysfunction

Men of all ages frequently experience erectile dysfunction (ED) or impotence, and it is a difficult health issue that adversely affects the quality of life of those who experience it. There are multiple types of treatment strategies for ED available, depending on the origin and severity of ED, as well as any underlying medical issues. However, these therapeutics are known to have a number of negative health effects. In contrast, plant-based treatments are more effective for managing diseases due to their ability to modulate biological processes like inflammation, oxidative stress, and cell signaling molecules. Many medicinal plants have been reported to be quite helpful in the improvement of ED. In this review, ED and its causes, diagnostic methods, treatment strategies, and some of the most potent plant-based interventions against ED are discussed in greater detail, along with a description of their mechanisms of action and a brief discussion of approaches to increase their efficacy, with a focus on the management of ED using herbal interventions as complementary and alternative medicines. While there is hope that medicinal plants could provide lead substances for erectile dysfunction medications, additional investigation is necessary to ascertain the efficacy and security of these prospective treatments.

(381) Infertility, Erectile Dysfunction, and Hypogonadism Medications in the NFL: A Comprehensive Analysis of the Substance Abuse Policy, Violation Penalties, and Therapeutic Use Exemptions

Abstract Introduction The National Football League (NFL) faces countless challenges in maintaining a fair and competitive playing field while protecting player health. One aspect of concern involves the use of medications to treat infertility, erectile dysfunction (ED), and hypogonadism, which can potentially alter and enhance athletic performance. The NFL's Substance Abuse Policy governs the use of such medications and imposes strict penalties for violations. Several important players have been affected by these rules while attempting treatment for legitimate medical conditions. This project explored the presence of infertility, ED, and hypogonadism treatments among NFL players, assessed the penalties for their misuse, and analyzed the process for obtaining Therapeutic Use Exemptions (TUEs). Objective To provide in-depth analysis of the NFL's Substance Abuse Policy involving medications for infertility, ED, and hypogonadism treatment. Specifically, we evaluated the presence of specific medications in question as compared with the guidelines established by the World Anti-Doping Agency (WADA), examined the penalties associated with misuse, and investigated the procedures for obtaining TUEs. Methods We obtained a copy and conducted a thorough analysis of NFL’s Substance Abuse Policy, focusing on the presence of commonly prescribed medications to treat infertility, ED, and hypogonadism. This was compared to existing WADA guidelines. We then evaluated specific testing procedures and penalties associated with their use. We finally analyzed and delineated the methodology for obtaining a TUE. Results Our analysis of the Substance Abuse Policy revealed 97 prohibited substances encompassing Anabolic/Androgenic Steroids, Protein and Peptide Hormones, Anabolic Agents including Beta-2 Agonists, Anti-Estrogenic Agents, Selective Androgen Receptor Modulators (SARMs). This list was found to be 98% consistent with existing WADA guidelines. Erectile Dysfunction medications were allowed, specifically Viagra, Cialis, and Levitra. Penalties for violating League Policy ranged from fines (calculated using player-specific salary), suspension, bonus forfeiture, and banishment. Regarding TUEs, specifically for hypogonadism, the application process proved to be complex, requiring substantial medical documentation, laboratory testing including FSH, LH, and semen analysis, and expert review. Obtaining a TUE additionally required annual renewal as well as regular serum testing and medical visits. Conclusions The use of medications treating infertility and hypogonadism among NFL players is a valid medical concern. While potential for abuse exists, many players qualify for treatment based on current medical guidelines. The Substance Abuse Policy was comprehensive, including all major infertility and hypogonadism medications while allowing use of common ED medications. Penalties for violations were strict but accompanied by associated review and appeal processes. The TUE system, while complex and time-intensive, provided pathways for players with genuine medical needs to access necessary treatments while maintaining organizational oversight. This study showed the delicate balance maintained by a multi-billion-dollar industry in promoting fair play while simultaneously allowing players to obtain legitimate medical treatments. Further research and collaboration between medical professionals, players, and league officials is needed to further refine this process for future generations. Disclosure No.

(317) Significant Cost Savings for Erectile Dysfunction Medications are Available Using Discount Online Pharmacies Compared to Medicare

Abstract Introduction The Mark Cuban Cost Plus Drug Company (CPD) is an online retailer launched in January 2022 that sells generic prescription medications directly to consumers at cost of ingredients and manufacturing plus a fixed 15% margin in addition to a small pharmacy dispensing fee and shipping fee. GoodRx is an online tool which offers coupons redeemable at pharmacies for discounts on prescription medications. The combination of these two tools offers physicians a way to provide prescription medications to patients at lower costs, which may lead to improved medication adherence and lower medication expenditures nationally. Objective To compare the cost of various erectile dysfunction medications when purchased through retail pharmacies, reimbursed through Medicare, or obtained utilizing CPD and GoodRx. Methods A review of publicly available data from CPD and GoodRx was performed to obtain average retail and discounted prices for generic sildenafil, tadalafil, and vardenafil. GoodRx prices were obtained using prices from Costco, CVS, Walgreens, and Walmart pharmacies in the most from populous zip code from each of the 3 most populous U.S. states: California, New York, and Texas. Prices were adjusted to account for dosage and prescribed quantity to estimate an average cost per dosage unit ($/adu). The Medicare Part D Drug Spending and Utilization data from 2021 were used to report the average spending per dosage unit and total expenditure for each of the listed medications. These data were compared to create an estimate of average national savings after use of CPD or GoodRx. Results Average spending per dosage unit for sildenafil, tadalafil, and vardenafil was less when GoodRx or CPD were used (0.28 $/adu, 0.31 $/adu, and 6.17 $/adu respectively), compared to Medicare pricing (2.14 $/adu, 8.08 $/adu, and 27.84 $/adu respectively) or retail pricing (0.52 $/adu, 2.82 $/adu, and 8.35 $/adu respectively). When adjusted for total dosage units, use of CPD over Medicare pricing for the three medications would result in a combined annual national saving of $149M. Use of either CPD or GoodRx compared to retail pricing would similarly result in a combined annual nation saving of $40M. Conclusions The utilization of CPD and GoodRx in the prescription of common erectile dysfunction medications may lead to significant reductions in pricing compared to retail and Medicare estimates. Knowledge of these prescription tools may lead to significant reductions in national expenditures on medications and decreased cost burden for patients seeking treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(209) Four-Year Real-world Sexual Function Outcomes of Rezum Therapy in Patients With and Without Erectile Dysfunction

Abstract Introduction Multiple studies have demonstrated Rezum therapy to effectively alleviate lower urinary tract symptoms secondary to benign prostatic hyperplasia while preserving sexual function. However, long-term real-world outcomes on sexual function are lacking in patients with baseline erectile dysfunction (ED) following Rezum treatment. Objective To compare four-year sexual function outcomes after Rezum between patients with and without baseline ED. Methods A retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017-2019. Patients were stratified into one of two cohorts based on presence or absence of ED at baseline. Sexual function was assessed with the validated 15-question International Index of Erectile Function (IIEF) questionnaire. Those who completed the IIEF questionnaire at baseline and 6-, 12-, and/or 48-months postoperatively were included. Function domains were calculated based on IIEF guidelines on clinical application of the questionnaire, and included erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Results Ninety-one patients were included: 44% (40) with baseline ED and 56% (51) without baseline ED. At baseline, 50% of the ED cohort were taking ED medications. No significant differences were found in age, prostate volume, and past medical history of hypertension or dyslipidemia between the cohorts. The ED cohort had a significantly greater proportion of patients with diabetes mellitus when compared to non-ED cohort (35 vs 15.7%, p=0.048). At baseline, the ED cohort had significantly lower scores for the IIEF domains of erectile function (p=0.007), orgasmic function (p=0.034), intercourse satisfaction (p=0.033), and overall satisfaction (p=0.002) when compared to the no ED cohort. Between the cohorts, no significant differences in the number of injections utilized during treatment in the lateral or medial prostatic lobes were observed. Compared to baseline, there was no significance in any IIEF domains in either cohort at 6-months. At 12-months, the ED cohort had significant percent decreases in orgasmic function (-25%, p=0.018), sexual desire (-22.2%, p=0.039), and overall satisfaction (-33.3%, p=0.004), while the non-ED cohort had a significant percent increase in erectile function (5%, p=0.04) when compared to baseline. At 48-months, the non-ED cohort had no significant changes in any IIEF domains, while the ED cohort had significant percent increases in erectile function (30%, p=0.013), sexual desire (22.5%, p=0.023), intercourse satisfaction (20%, p=0.011), and overall satisfaction (58.3%, p=0.008). At 48-months, there were no cases of de novo ED in the non-ED cohort and no significant changes in ED medications in the ED cohort when compared to baseline (53.3 vs 46.7%, p=0.72). Conclusions At long-term, Rezum preserved sexual function in patients with no baseline ED and improved sexual function in patients with baseline ED. However, patients with baseline ED may experience temporary decreases in sexual function at 12-months postoperatively. Additional larger studies are warranted to further evaluate these real-world results. Disclosure No.

(307) Prevalence of Sexual Dysfunction and Pursuit of Sexual Medicine Evaluation Among Male Physicians

Abstract Introduction While the epidemiology of male sexual dysfunction in the general population is well studied, little is known regarding the prevalence of sexual dysfunction in male physicians and their likelihood of seeking treatment. Objective To characterize the prevalence of sexual dysfunction, evaluation patterns, and barriers to treatment among male physicians. Methods Between June 2022 and October 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). Results 235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years. 27 (11.5%) reported having seen a doctor for sexual health. Of these 27,11 (40.7%) saw a physician for erectile dysfunction, 8 (29.6%) for low libido, 6 (22.2%) for premature ejaculation, 2 (7.4%) for delayed ejaculation, and 9 (33.3%) for some other concern. An additional 29 (13.9%) respondents considered establishing care for sexual issues but didn’t, mostly due to being too busy (N=18, 62.1%). Of the 56 respondents who had either seen or thought about seeing a physician for sexual health issues, the mean IIEF score was 24.4 ± 8.7 with 18 (32.1%) qualifying as having at least mild ED and 7 (12.5%) having severe ED (Table 2). 46 (19.6%) respondents reported having taken medication to improve erectile function. Only 12 (5.1%) respondents reported having ever been diagnosed with low testosterone. Among the 56 respondents who had either seen or thought about seeing a physician for sexual health issues, those who worked more hours (>60 hours per week) were least likely to see a physician (7.2%) compared to those working the fewest hours (33.3%), p=0.02. Conclusions In a cohort of young male physicians, 25.4% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Given the highly demanding work schedules, occupational stress, and a variety of other factors associated the medical profession, male physicians appear to be at higher risk for sexual dysfunction than the general population. Moreover, male physicians face significant and unique barriers in access to care for sexual dysfunction. Disclosure No.

(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<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<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<0.001). Income >$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, <0.001, <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<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.

(158) Antihypertensive Medications and Erectile Dysfunction: Is this Association Accurate?

Abstract Introduction The association between erectile dysfunction (ED) and antihypertensive medications (AM) has been previously described with varying results in small or single center data sets. Utilizing large post marketing surveillance databases allows one to study drug side effects across patients in a much larger and more diverse sample size. Objective Our study sought to investigate AMs and their medication classes to determine the incidence of ED. Our hypothesis was that thiazide diuretics and beta blockers would have significantly higher rates of reported ED than other AM classes due to the classic association with these medications and ED. Methods We utilized the US government Medical Expenditure Panel Survey maintained by the Agency for Healthcare Research and Quality to determine the total number of patients on each medication each year. The total number of ED adverse events reported per year per medication was accessed via the Food and Drug Administration’s adverse event reporting database (FAERS). Date ranges were 2013 to 2020. We reviewed all substantive outpatient AMs and compared them to one another as well as across the class with regards to reported ED rates. Results We found that a higher incidence of ED adverse events were reported with ramipril and bisoprolol -15 events per 100,000 patients and 34.1 events per 100,000 patients, respectively. Interestingly fewer adverse events (0.4 events per 100,000 patients) were reported for lisinopril. We did recognize differences among AM classes via Kruskal-Wallis analysis however the structure of our study was not able to distinguish which class was different in rates of ED as a result of the large number of drugs included. Reported ED rates increased over the study period with 2020 having the most ED reports. However, most medications reported fewer than 100 adverse events over an 8-year time period with many medications having tens of millions of patients taking them a year. Conclusions Higher rates of reported ED were seen with ramipril and bisoprolol and lower rates found with lisinopril than in other AMs. Differences among medication classes were not identified. The infrequent reporting of ED with AMs questions the existing dogma that AMs cause ED and further consideration should be given to the causality of this association. Disclosure No.

(163) The High Price of Anonymity: Comparison of Cost of Direct-to-Consumer Mail Order Pharmacies Compared with Cost Plus Drug Company

Abstract Introduction Direct-to-consumer (DTC) mail order pharmacies often entice patients with erectile dysfunction (ED) by highlighting the ability to obtain medication online and avoid an “awkward” doctor’s visit. The markup and cost of obtaining medications for ED through subscription services from DTC pharmacies that include a “telemedicine” visit remains unknown. Objective To compare the cost of generic ED medications available from DTC mail order pharmacies to Mark Cuban Cost Plus Drug Company. Methods We obtained the cost of medications from three direct-to-consumer online mail order pharmacies (hims, BlueChew, and Roman) as well as comparable medications which are available with a prescription from Mark Cuban Cost Plus Drug Pharmacy. Cost per pill, monthly costs, and annual costs were compared in a variety of subscription options from DTC pharmacies compared with Cost Plus Drug Company. Results Introductory packages of sildenafil started at $25/month at BlueChew (30mg, 6 pills/month, $4.17/pill), $26/month at hims (25mg, 4 pills/month, $6.50/pill), and $16/month at Roman (25mg, 4 pills/month, $6.25/pill). Alternatively, 30 pills at Cost Plus Drug Company costs $9.40 (20mg, 30 pills/month, $0.32/pill). Introductory packages of tadalafil started at $25/month at BlueChew (6mg, 4 pills/month, $6.25/pill), $30/month at hims (10mg, 4 pills/month, $7.50/pill)), and $39/month at Roman (5mg, 4 pills/month, $9.75/pill). Alternatively, 30 pills at Cost Plus Drug Company was $10.70 (10mg, 30 pills/month, $0.36/pill). The cheapest per pill price of sildenafil is $2.79 at BlueChew (30mg), $4.00 at hims (25mg), and $2.80 at Roman (25mg). To obtain the lowest price, patients are required to commit to 34 pills/month at $90 from BlueChew, a 12-month subscription for 16 pills/month totaling $768 from hims, and a 12-month subscription of 10 pills/month totaling $336 from Roman. The cheapest cost/pill at Cost Plus Drug Company was $0.15/pill (20mg) to obtain 90 pills for $13.40. These values are even more stark when ordering the highest strength and highest quantity of tadalafil for 1 year from each of DTC pharmacy: BlueChew $1,445 (9mg, 28/month, $4.30/pill), hims $1,284 (10mg, 16/month, $6.69/pill), and Roman $5,136 (20mg, 10/month, $42.80/pill)). 360 tabs of Tadalafil 20mg from Cost Plus Drug Company cost $75.20, $0.21/pill). This analysis is limited as the cost of a doctor’s visit to obtain a prescription is not included in the price of medications at Cost Plus Drug Company but is included in the direct-to-consumer services. Conclusions Direct-to-consumer online pharmacies that include a telehealth appointment and provide access to generic medications to treat ED have considerable markup. This markup likely exceeds the out-of-pocket cost for a primary care office visit needed to obtain a prescription to treat ED. Prescribers should inform patients of cost-effective methods to obtain commonly used medications to treat ED. Disclosure No.

Genetic prediction of modifiable lifestyle factors for erectile dysfunction.

The causal relationship between certain lifestyle factors and erectile dysfunction (ED) is still uncertain. The study sought to investigate the causal effect of 9 life factors on ED through 2-sample single-variable Mendelian randomization (SVMR) and multivariable Mendelian randomization (MVMR). Genetic instruments to proxy 9 risk factors were identified by genome-wide association studies. The genome-wide association studies estimated the connection of these genetic variants with ED risk (n = 223 805). We conducted SVMR, inverse variance-weighting, Cochran's Q, weighted median, MR-Egger, MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier), and MVMR analyses to explore the total and direct relationship between life factors and ED. The primary outcome was defined as self or physician-reported ED, or using oral ED medication, or a history of surgery related to ED. In SVMR analyses, suggestive associations with increased the risk of ED were noted for ever smoked (odds ratio [OR], 5.894; 95% confidence interval [CI], 0.469 to 3.079; P = .008), alcohol consumption (OR, 1.495; 95% CI, 0.044 to 0.760; P = .028) and body mass index (BMI) (OR, 1.177; 95% CI, 0.057 to 0.268; P = .003). Earlier age at first intercourse was significantly related to reduced ED risk (OR, 0.659; 95% CI, -0.592 to -0.244; P = 2.5 × 10-6). No strong evidence was found for the effect of coffee intake, time spent driving, physical activity, and leisure sedentary behaviors on the incidence of ED (All P > .05). The result of MVMR analysis for BMI (OR, 1.13; 95% CI, 1.01 to 1.25; P = .045) and earlier age at first intercourse (OR, 0.77; 95% CI, 0.56 to 0.99; P = .018) provided suggestive evidence for the direct impact on ED, while no causal factor was detected for alcoholic drinks per week and ever smoked. This study provides evidence for the impact of certain modifiable lifestyle factors on the development of ED. We performed both SVMR and MVMR to strengthen the causal relationship between exposures and outcomes. However, the population in this study was limited to European ancestry. Ever smoked, alcoholic drinks per week, BMI, and age first had sexual intercourse were causally related to ED, while the potential connection between coffee intake, physical activity, recreational sedentary habits, and increased risk of ED needs to be further confirmed.

Prevalence of sexual dysfunction and pursuit of sexual medicine evaluation among male physicians-a survey.

We sought to characterize the prevalence of sexual dysfunction and barriers to treatment among male physicians. Between June and December 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). In totla, 235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years (range 23-72). 27 (11.5%) reported having seen a doctor for sexual health. Of these 27, 40.7% saw a physician for erectile dysfunction, 29.6% for low libido, 22.2% for premature ejaculation, 7.4% for delayed ejaculation, and 33.3% for other concerns. An additional 29 (12.3%) considered establishing care for sexual issues but didn't, mostly due to being too busy. 46 (19.6%) respondents reported having taken medication to improve erectile function. Therefore, in a cohort of young male physicians, 23.8% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Male physicians appear to be at higher risk for sexual dysfunction than the general population and face significant and unique barriers in access to care for sexual dysfunction.

Prescription, offer and access to medications for erectile dysfunction: a paradox in public health?

This is an opinion-based article that aims to reflect on the antagonism established between the National Policy of Integral Attention to Men's Health (PNAISH) with specific focus on ED (Erectile Dysfunction), directed to access to medication. It is well-known that PNAISH presents objectives that go beyond sexual and reproductive health, especially, even after 13 years of its publication, since there was no incorporation of medications to treat ED within the SUS. This article was developed based on the scenario observed in the daily care of patients who undergo treatment in the Men's Health Outpatient Service of a High-Complexity Hospital. According to this perspective, it is important to emphasize, that the prescription of medications within the SUS should faithfully follow the Rename; as recommended by Decree 7,508, observing the Resolution SS-83 of 2015, in the state of São Paulo. This establishes that the cost of dispensing medications not included in the SUS pharmaceutical assistance protocols, through judicialization, prescribed by a physician in the state health network, may be funded by the institution to which this physician is affiliated.

Sudden death related to sexual activity: A multicenter study based on forensic autopsies (2010–2021)

Introduction and objectivesTo investigate the epidemiological characteristics, clinic-pathological findings and recent use of substances of abuse and prescribed drugs in sexual activity-related sudden death (SArSD). MethodsMulticenter population-based study on forensic autopsies conducted in 27 provinces of Spain over 12 years (2010–2021). ResultsOut of 18046 autopsied natural deaths, 64 cases (0.35 %) of SArSD were investigated (87 % males). Women were younger than males (50.5 ± 13.4 years vs 37.2 ± 14.2; p = 0.017). Sudden cardiac deaths (SCD) accounted for 87 % of cases. Ischemic heart disease was the predominant pathology (58 %), mainly affecting men ≥ 36 years of age. Cerebral haemorrhage (8 %) and asthma (5 %) were the leading non-cardiac causes. In young adults, SADS (36 %) and asthma (27 %) were the main causes The disease responsible of SCD was diagnosed in life in 7 subjects. In 64 % there were cardiovascular risk factors, mainly obesity. Toxicological analysis detected illicit drugs (23 %), mainly cocaine, medications for erectile dysfunction (9 %), and ethanol ≥ 0.5 g/L (8 %). Deaths occurred usually in the context of heterosexual intercourse and during or immediately after sexual activity. The most common location was at home (63 %). In 12 men the sexual partner was a sex worker. ConclusionsSArSD has a low incidence in the general population affecting middle-aged males during intercourse with a heterosexual partner. It is of cardiovascular origin, mainly due to ischemic heart disease that frequently remained silent during life. There is a frequent association with obesity, use of cocaine (and, to a lesser extent, medications for erectile dysfunction) and performing unconventional sexual practices. Forensic investigation is useful for developing prevention strategies.

Sexual and reproductive health of baby boomers.

Early baby boomers constitute a cohort that was the first to benefit from numerous innovative interventions in sexual and reproductive health services as exemplified by hormonal contraception, legal abortion, invitro fertilisation, screening mammography and menopausal hormone replacement besides medication for male erectile dysfunction. The quest for a youth elixir continues to be a challenge for sexual health sciences.

Identification of Emotional Spectrums of Patients Taking an Erectile Dysfunction Medication: Ontology-Based Emotion Analysis of Patient Medication Reviews on Social Media.

Patient medication reviews on social networking sites provide valuable insights into the experiences and sentiments of individuals taking specific medications. Understanding the emotional spectrum expressed by patients can shed light on their overall satisfaction with medication treatment. This study aims to explore the emotions expressed by patients taking phosphodiesterase type 5 (PDE5) inhibitors and their impact on sentiment. This study aimed to (1) identify the distribution of 6 Parrot emotions in patient medication reviews across different patient characteristics and PDE5 inhibitors, (2) determine the relative impact of each emotion on the overall sentiment derived from the language expressed in each patient medication review while controlling for different patient characteristics and PDE5 inhibitors, and (3) assess the predictive power of the overall sentiment in explaining patient satisfaction with medication treatment. A data set of patient medication reviews for sildenafil, vardenafil, and tadalafil was collected from 3 popular social networking sites such as WebMD, Ask-a-Patient, and Drugs.com. The Parrot emotion model, which categorizes emotions into 6 primary classes (surprise, anger, love, joy, sadness, and fear), was used to analyze the emotional content of the reviews. Logistic regression and sentiment analysis techniques were used to examine the distribution of emotions across different patient characteristics and PDE5 inhibitors and to quantify their contribution to sentiment. The analysis included 3070 patient medication reviews. The most prevalent emotions expressed were joy and sadness, with joy being the most prevalent among positive emotions and sadness being the most prevalent among negative emotions. Emotion distributions varied across patient characteristics and PDE5 inhibitors. Regression analysis revealed that joy had the strongest positive impact on sentiment, while sadness had the most negative impact. The sentiment score derived from patient reviews significantly predicted patient satisfaction with medication treatment, explaining 19% of the variance (increase in R2) when controlling for patient characteristics and PDE5 inhibitors. This study provides valuable insights into the emotional experiences of patients taking PDE5 inhibitors. The findings highlight the importance of emotions in shaping patient sentiment and satisfaction with medication treatment. Understanding these emotional dynamics can aid health care providers in better addressing patient needs and improving overall patient care.

Periodontitis as a risk factor for organic erectile dysfunction: A case-control study in a sub-Saharan population.

This study investigated the association between periodontitis and organic erectile dysfunction (ED) in a sub-Saharan population. This multicenter analytical study lasted from April to September 2021. A total of 114 patients (38 cases and 76 controls) were recruited and matched on age, diabetes, and smoking status. Medical history and ED were recorded, as well as the plaque index, bleeding index, maximum interdental clinical attachment loss (CALmax), maximum probing depth, clinically detectable furcation involv ement, number of teeth in the mouth, number of teeth lost for periodontal reasons, and tooth mobility. The analysis was performed with SPSS 20.0 with a significance threshold set at 5%. The two study groups were comparable regarding sociodemographic characteristics. Periodontitis was present in 76.31% of cases and 75% of controls without a significant difference (P=0.878). Logistic regression showed a significant association between high blood pressure and ED with an OR=4.78 (95% CI: 1.80‒12.70). Periodontitis was not associated with ED (OR=1.52, 95% CI: 0.55‒4.16); however, severe periodontitis was significantly associated with severe ED (OR=1.44, 95% CI: 1.11‒1.85, and OR=1.68, 95% CI: 1.15‒2.44, respectively for CALmax and tooth loss). Within the limits of this study, periodontitis was not associated with organic ED. However, the severity of periodontal disease significantly increased in patients with organic ED.

Improving Erectile Dysfunction Management Among Asian Men With Diabetes Using the Knowledge Translation Intervention.

Erectile dysfunction (ED) is frequently undermanaged due to communication barriers, particularly among Asian men. We looked at how ED discussion and treatment were affected by the patient's prompt sheet and the Knowledge Translation Tools in the Management of Erectile Dysfunction (LASTED). We conducted a quasi-experimental study in a primary care clinic in Kedah, Malaysia involving 120 Asian men with diabetes. In the intervention group, patients were given a prompt sheet to indicate their intention to discuss or receive ED treatment, and physicians were provided with LASTED to assist with ED consultation. The control group patients received standard care from their physicians. The intervention increased the initiation of ED discussion up to 66.7% compared with 8.3% in the control group. In the intervention group, 57.5% of patients were prescribed phosphodiesterase-5 inhibitors and men with ED of moderate severity were more likely to be prescribed oral ED medication. Use of the LASTED flipchart was associated with prescription of phosphodiesterase-5 inhibitors (P = .011) and patient satisfaction with ED consultation (P <.001). Our study suggests that using the LASTED flipchart and patient's prompt sheet together may encourage ED conversation and medication prescription particularly when working with Asian men who frequently view ED as a taboo subject.

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.

Emergency Department Evaluation of Priapism: Etiology and Consultation

Introduction: Priapism is a time-critical condition requiring immediate evaluation and management to avoid significant sequela. Management of this condition is significantly variable, dependent upon the underlying cause, and often instituted by a consultant rather than the treating emergency physician. Objectives: To determine etiologic factors contributing to priapism treatment and determine if treatments initiated in the emergency department (ED) contribute to an improved disposition metric. Methods: We conducted a multi-center, retrospective study of patients with priapism caused by multiple different etiologies. Study subjected were located at 15 hospitals by chart review and conducted a computer-assisted chart review to locate patients with priapism for each hospital over a 2-year period. Results: We evaluated 236 patients during the study period; 8 excluded for chart unavailable and 6 with non-priapism diagnosis on review. Median age was 39 years (IQR 22-52). Pediatrics, defined as less than 21 years of age, comprised 4% of patients (N=9). Overall, 85% (N=188) were discharged. Erectile dysfunction medications (EDM) were the most common identifiable cause; involving 23% (N=52). The remaining were sickle cell 20% (N=45), antipsychotic medications 14% (N=30), cocaine 2% (N=4), the remainder without an identifiable etiology. Overall, intrapenile procedures occurred in 56% (N=125) of patients. EDM was associated with significantly less intrapenile procedures compared to other etiologies, 15% (N=58) (p = 0.009), and also had a 2% (N=1) admission rate, significantly less compared to other etiologies (p=0.009). Further, consulting urology did not significantly increase mean length of stay, with difference of 19 minutes (p=0.64) when compared to ED intervention alone. Conclusion: Priapism as a result of EDM, the most frequent etiology, was associated with less frequent emergent intrapenile procedures and significantly less admissions and urology consultation does not significantly lengthen disposition times.

Fentanyl, heroin, and methamphetamine-based counterfeit pills sold at tourist-oriented pharmacies in Mexico: An ethnographic and drug checking study

BackgroundFentanyl- and methamphetamine-based counterfeit prescription drugs have driven escalating overdose death rates in the US, however their presence in Mexico has not been assessed. Our ethnographic team has conducted longitudinal research focused on illicit drug markets in Northern Mexico since 2018. In 2021–2022, study participants described the arrival of new, unusually potent tablets sold as ostensibly controlled substances, without a prescription, directly from pharmacies that cater to US tourists. AimsTo characterize the availability of counterfeit and authentic controlled substances at pharmacies in Northern Mexico available to English-speaking tourists without a prescription. MethodsWe employed an iterative, exploratory, mixed methods design. Longitudinal ethnographic data was used to characterize tourist-oriented micro-neighborhoods and guide the selection of n=40 pharmacies in n=4 cities in Northern Mexico. In each pharmacy, samples of “oxycodone”, “Xanax”, and “Adderall” were sought as single pills, during English-language encounters, after which detailed ethnographic accounts were recorded. We employed immunoassay-based testing strips to check each pill for the presence of fentanyls, benzodiazepines, amphetamines, and methamphetamines. We used Fourier-Transform Infrared Spectroscopy to further characterize drug contents. ResultsOf n=40 pharmacies, one or more of the requested controlled substances could be obtained with no prescription (as single pills or in bottles) at 28 (70.0%) and as single pills at 19 (47.5%). Counterfeit pills were obtained at 11 pharmacies (27.5%). Of n=45 samples sold as one-off controlled substances, 18 were counterfeit. 7 of 11 (63.6%) samples sold as “Adderall” contained methamphetamine, 8 of 27 (29.6%) samples sold as “Oxycodone” contained fentanyl, and 3 “Oxycodone” samples contained heroin. Pharmacies providing counterfeit drugs were uniformly located in tourist-serving micro-neighborhoods, and generally featured English-language advertisements for erectile dysfunction medications and “painkillers”. Pharmacy employees occasionally expressed concern about overdose risk and provided harm reduction guidance. DiscussionThe availability of fentanyl-, heroin-, and methamphetamine-based counterfeit medications in tourist-oriented independent pharmacies in Northern Mexico represents a public health risk, and occurs in the context of 1) the normalization of medical tourism as a response to rising unaffordability of healthcare in the US, 2) plummeting rates of opioid prescription in the US, affecting both chronic pain patients and the availability of legitimate pharmaceuticals on the unregulated market, 3) the rise of fentanyl-based counterfeit opioids as a key driver of the fourth, and deadliest-to-date, wave of the opioid crisis. It was not possible to distinguish counterfeit medications based on appearance of pills or geography of pharmacies, because identically-appearing authentic and counterfeit versions were often sold in close geographic proximity. Nevertheless, people who consume drugs may be more trusting of controlled substances purchased directly from pharmacies. Due to Mexico’s limited opioid overdose surveillance infrastructure, the current death rate from these substances remains unknown.