Erectile Function In Men Research Articles

Modified calculation of the IIEF6-a more accurate assessment of erectile function in middle-aged men.

The Erectile Function Domain of the International Index of Erectile Function (IIEF6) is inaccurate in assessing erectile function in men who are not practicing sexual intercourse. Improvement through a modification was recently tested on patients after radical prostatectomy. This study examines the application of this modification in a population-based cohort of middle-aged men. To assess the feasibility of a modified IIEF6 in a population-based random sample of 50-year old men in Germany. 4924 men were included. IIEF6, Erection Hardness Score (EHS), and causes for the absence of sexual intercourse within the previous 4weeks were assessed. Modified calculation (double weighting of non-intercourse IIEF6 questions) was applied in case of absence due to external circumstances. Impact of the modification on erectile dysfunction (ED) prevalence and agreement between IIEF6 and EHS in ED classification. As a result of the modified calculation, ED prevalence in the overall study sample decreased by 6.2% to a rate of 27.2%. Agreement between IIEF6 and EHS was increased from 2.7% to 73.4% in men with no sexual intercourse due to external circumstances. An additional inquiry into the reason for the absence of sexual intercourse and modified calculation enhances the accuracy of IIEF6 in evaluating erectile function of the individual man. This study comprises a large population-based sample. As the study population was exclusively 50-year-old men, results may not be representative of the population average. A more accurate evaluation of an individual man's erectile function may be achieved by using a modified version of the IIEF6.

Оценка влияния многокомпонентного комплекса с растительными экстрактами на основные параметры эректильной функции у мужчин.

Introduction. Male infertility is a complex disease with many potential causes, including hormonal imbalance, anatomical problems, genetic factors, lifestyle factors, and more. Currently, there is a fairly large group of infertile men with unspecified causes of the disease. Introduction. Erection is a neurovascular process that is regulated by psychological factors and endocrine status. Erectile dysfunction can be based on various causes – psychological, neurological, endocrinological, vascular – arterial and related to impaired functioning of the cavernous bodies, or a combination of the above factors. The assessment of the factors that lead to erectile dysfunction in this particular man is fundamentally important for choosing the right treatment tactics. Among the many methods of correcting erectile disorders, herbal components and other biologically active substances are currently actively used to enhance testosterone synthesis, libido stimulation and erection. Objective. To evaluate the effect of the dietary supplement Vuka Forte on the main parameters of erectile function in men. Materials and methods. This article describes analyzed data from 45 men with erectile disorders of various etiologies, with complaints of a decrease in the quality of adequate erections of mild and moderate severity at the age of 34 to 55 years and the duration of the disease from 6 months to 9 years, who were recommended dietary supplement Vuka Forte. The complex was used by men 1 tablet 1 time per day with meals in the morning for 1 month. The results were evaluated 1 month after the start of taking the Vuka Forte dietary supplement. An objective (physical) examination was performed. Laboratory diagnostics included the determination of the following indicators: biochemical profile, total testosterone, albumin, LH (luteinizing hormone), insulin, glucose, glycosylated hemoglobin, lipid profile. The assessment of the quality of life and sexual function of men was carried out on the IPSS scale (International System for the Summary Assessment of Prostate Diseases, Lower Urinary Tract Symptoms (GMP)) and IIEF-15 (International index of erectile function). Results. According to the results of our work, the use of Vuka Forte dietary supplements in men with various erectile disorders, including those associated with metabolic disorders, especially in the early stages of its development, contributes to the restoration of insulin receptor sensitivity, normalization of carbohydrate and lipid metabolism, endothelial function. The use of Vuka Forte dietary supplements is accompanied by a statistically significant improvement in erectile function to the level of mild erectile disorders or their absence, stabilization of the hormonal background, and improvement in the quality of life in general. Conclusions. The results indicate the possibility of using the dietary supplement Vuka Forte as a multicomponent complex for men with various erectile dysfunctions, including those associated with metabolic disorders of any severity, and its use is justified.

Nutraceutical interventions for erectile dysfunction: a systematic review and network meta-analysis.

Although nutraceutical-based treatments are often offered for erectile dysfunction (ED), their efficacy remains doubtful, and the choice of one substance over the other is challenged by the dearth of head-to-head comparative studies. We aimed to compare the efficacy of available nutraceutical interventions, alone or in combination with phosphodiesterase type 5 inhibitors (PDE5i), in improving erectile function in men with ED through a network meta-analysis (NMA), which incorporates direct and indirect evidence into one model thus generating a hierarchy of effectiveness. PubMed, Scopus, Web of Sciences, and Cochrane Library databases were searched for randomized placebo-controlled trials (RCTs) assessing the effect of any nutraceutical regimen in improving erectile function when compared to each other, placebo, and/or PDE5i in men with ED. Data were included in a random-effects NMA, where efficacy of treatments was ranked by surface under the cumulative ranking curve (SUCRA). Two NMAs were also conducted separately for organic and non-organic ED. Reciprocal comparisons between all treatments were analyzed by league tables. The main outcome was the standardized mean difference in the score of the International Index of Erectile Function (IIEF)-5 or IIEF-6. Fifteen RCTs provided information on 1000 men with ED. In the overall NMA, compared to placebo, the combination propionyl L-carnitine (PLC) + acetyl L-carnitine (ALC) + Sildenafil was associated with the highest SUCRA (97%) in improving erectile function score, followed by L-Arginine + Tadalafil (84%), Sildenafil (79%), Tadalafil (72%), and L-Arginine (52%). No other treatment regimen showed efficacy with statistical significance. In patients with organic ED, the efficacy of Sildenafil and Tadalafil was significantly improved by PLC + ALC and L-Arginine, respectively. On the contrary, in non-organic ED, nutraceuticals did not improve the therapeutic performance of daily Tadalafil. This NMA contributes valuable insights into the potential of nutraceutical interventions for ED. We employed strict inclusion criteria related to study design and diagnostic tool, ensuring the assumption of transitivity and the consistency of the analysis. Against a background of general ineffectiveness of most nutraceutical interventions, L-Arginine and the mix PLC + ALC appeared to be of some usefulness in improving erectile function, especially in combination with PDE5i in organic ED.

Association between sex hormones and erectile dysfunction in men without hypoandrogenism

In addition to testosterone, various endocrine hormones, such as dehydroepiandrosterone sulfate (DHEA-S) and estradiol, may be involved in erectile function. However, the role of these sex hormones in the erectile function of men without hypoandrogenism remains unclear. This cross-sectional study included 398 community-dwelling men without hypoandrogenism. The participants were categorized into the non-ED and ED groups. Multivariable logistic regression analyses were performed to investigate the relationship between ED and serum sex hormone levels, including total testosterone, DHEA-S, estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin. Among the 398 men, 66 (17%) and 332 (83%) were categorized into the non-ED and ED groups, respectively. In the multivariable analyses, serum DHEA-S and estradiol levels were significantly associated with ED (odds ratio [OR]: 0.996, P = 0.030; OR: 1.082, P = 0.002; respectively), whereas serum total testosterone, LH, FSH, and prolactin levels did not demonstrate significant association. After adjusting for age, none of neutrophil-to-lymphocyte ratio, serum plasminogen activator inhibitor-1 levels, and skin advanced glycation end-products levels demonstrated significant correlation with serum DHEA-S and estradiol levels. In conclusion, lower testosterone levels did not affect ED in men with normal testosterone levels, whereas serum DHEA-S and estradiol levels were significantly associated with ED.

GLP-1RAs boost erectile function in men with type 2 diabetes and erectile dysfunction: results from a 1-year retrospective cohort study

GLP-1RAs boost erectile function in men with type 2 diabetes and erectile dysfunction: results from a 1-year retrospective cohort study

Androgen State and Erectile Function in Men with Chronic Distress

The objective: to study the state of androgen supply and erectile function in men with chronic distress. Materials and methods. We examined 30 internally replaced males (Average age, M±σ=50.50±3.83) with manifestations of chronic distress (Group I) and 20 practically healthy males (Group II), (Average age, M±σ=51.95±4.60). All men underwent general clinical examination, body mass index evaluation, assessment of depression according to Hospital Anxiety and Depression Scale (HADS), assessment of symptoms of androgen deficiency according to the Aging Males’ Symptoms (AMS). Severity of erectile dysfunction was evaluated according to the International Index of Erectile Function scale (IIEF). The following parameters were determined in blood serum: luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), free testosterone (TF), estradiol (E), cortisol (K). Results. According to the HADS scores in group I men, the average anxiety domain score was 12.03±1.50 points, the average depression domain score was 13.93±1.49, and the total score was 26.0±2.64 points. In patients of group II, the average anxiety domain score was 2.20±0.88 points, the average depression domain score was 2.60±1.00, and the overall score was 4.80±1.40 points. The comparison of the total score of group I and the total score of group II is statistically significant (p<0.05). According to the AMS, in men of group I, androgen deficiency was more expressed comparing to the control group (45.93±3.30 and 13.30±2.04 points, respectively, p<0.001). Analysis of the IIEF-15 questionnaire revealed a decrease in all indicators of erectile function in men of group I comparing to group II. A study of the hormonal state showed a decrease in the level of TT in men of group I compared to the indicators of group II: 9.30±2.84 and 15.27±0.96 ng/ml, respectively (p<0.001). The average TF levels in group I were reduced comparing to group II and reached 10.23±1.38 and 17.39±1.03 pg/ml, respectively (p<0.001). The levels of LH and FSH in men of group I were within normal age-related fluctuations and did not differ statistically significantly from similar levels of group II. The average E level in men with chronic distress was significantly increased comparing to the control group and reached up to 0.25±0.05 versus 0.11±0.03 nmol/l, respectively (p<0.001). The average C level in men with chronic distress was significantly increased comparing the control group and reached up to 13.33±2.19 versus 6.72±1.33 μg/dL, respectively (p<0.001). Conclusions. 1. The survey results indicate that chronic distress is a factor that worsens sexual function in men. In addition to erectile dysfunction, as evidenced by a decrease in the corresponding IIEF integrative indicator 15 «erectile function», the survey found a decrease in both the frequency of occurrence and the degree of sexual desire, a deterioration in orgasmic sensations in the form of a decrease in the frequency of ejaculation and orgasms. 2. Cortisol is an important hormone that forms protective reaction in stressful situations, but loses its positive properties during chronic distress. A prolonged increase in cortisol levels can lead to a pathological condition accompanied by an increase in BMI, depression, anxiety, decreased testosterone levels and ED. 3. A decrease in testosterone levels in chronic distress and visceral obesity in men is not accompanied by a compensatory increase in LH and FSH levels. This can be explained by increased aromatization of testosterone in visceral adipose tissue and a decrease in the pituitary gland’s response to the development of androgen deficiency as a result of combined damage to the central and peripheral parts of the regulation of testosterone synthesis.

Erectile Function in Men during the COVID-19 Pandemic

This research focused on two age groups of men (under 40 and over 40 years) and their sexual function during the COVID-19 pandemic. Somatic examinations, including the measurement of hormone levels, were conducted on all patients. The subjects also completed two questionnaires and provided personal history data. The first questionnaire covered the evaluation of erectile function, while the second assessed psychosocial trauma and stress. The results in the first group (men under 40 years of age) showed a correlation between prolactin values and erectile function score results (R = 0.54), between erectile function score results and trauma and psychosocial stress symptoms (R = 0.49) and also between prolactin values and trauma and psychosocial stress symptoms (R = 0.53). The results in the second group (men over the age of 40) showed a correlation between prolactin values and erectile function score results (R = 0.42), between erectile function score results and trauma and psychosocial stress symptoms (R = 0.54) and between free testosterone level and erectile function score results (R = 0.32). These findings support the hypothesis of a different impact of stress on the development of erectile dysfunction in men under 40 and over 40 years of age during COVID-19.

(228) Cell-Based Therapy Can Restore Erectile Function in Men with Type 2 Diabetes and Metabolic Syndrome by Promoting Angiogenesis and Endothelial Repair

Abstract Introduction Although there has been a growing interest in restorative therapies for erectile dysfunction (ED) in recent years, there is still limited mechanistic evidence to support their effectiveness in the clinical setting. Objective The goal of this research was to investigate the mechanistic impact of cell-based therapy in men with ED secondary to Type 2 Diabetes Mellitus (DM2) and Metabolic Syndrome (MetS) through analysis of plasma biomarkers. Methods International Index of Erectile Function (IIEF) was completed by all men in the ACESO (NCT02886884) and CERES (NCT03059355) clinical trials. ACESO and CERES were both randomized, blinded, pilot phase clinical trials in which all participants received cellular therapy at varying doses and sources to treat endothelial dysfunction secondary to either DM2 or MetS, respectively. The intervention in both trials was peripheral intravenous infusion of allogeneic Mesenchymal Stem Cells (MSCs) of either 20 or 100 million cells derived from either bone marrow (BM) or umbilical cord tissue (UC). Follow-up was for 1 year. Endothelial function was measured via Brachial Artery Flow Mediated Vasodilation (FMD) and Endothelial Progenitor Cell-Colony Forming Units (EPC-CFU) assay. Plasma aliquots were isolated from blood samples and subjected to multiplex ELISA assay for analysis of angiogenic biomarkers. Results Data was pooled from all 20 men in the ACESO and CERES clinical trials. Overall, 7 received 20 million BM-MSCs, 9 received 100 million BM-MSCs, 2 received 20 million UC-MSCs, and 2 received 100 million UC-MSCs. There were no treatment emergent serious adverse effects (TE-SAEs) within 30 days following infusion in any of the participants. Among men with ED (IIEF-EF<25), 31.25% achieved MCID in erectile function. Participants with mild or moderate ED at baseline showed greater improvements in erectile function and endothelial function compared to those with severe ED. Participants who achieved MCID following cell therapy also experienced statistically significant improvements in FMD (P=0.05), whereas those who did not achieve MCID or had normal erectile function at baseline did not experience an improvement in FMD. Furthermore, men with Metabolic Syndrome who met MCID criteria were found to have increased Angiopoietin 1 and decreased Angiopoietin 2 following cell therapy. Conclusions The findings of this study demonstrate the potential of cell-based therapies in improving erectile function, angiogenic, and endothelial function. Future studies should aim to identify the causative mechanisms underlying these restorative effects in humans, paving the way for enhanced understanding and optimization of such therapies. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Longeveron LLC.

(153) Hyperbaric Oxygen Therapy as a Treatment for Erectile Dysfunction: A Meta-analysis

Abstract Introduction Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the patient is exposed to 100% oxygen at a higher than atmospheric pressure. Over the past few decades, HBOT has been used to treat a variety of medical conditions, including radiation cystitis, decompression sickness and carbon monoxide poisoning. In recent times, there has been a rising curiosity regarding the potential therapeutic benefits of hyperbaric oxygen therapy in the treatment of erectile dysfunction (ED), a prevalent condition that affects a vast number of men globally. Objective The aim of this study was to review and meta-analyze available data regarding the use of HBOT for erectile dysfunction, including its potential mechanisms of action and effectiveness. Methods Two investigators (GS and TN) screened 54 articles and included only those that evaluated the impact of HBOT on ED symptoms using the IIEF score. Prospective non-randomized studies or randomized controlled clinical trials were included, while non-original studies, conference abstracts, and case reports were excluded. Data extraction was performed in duplicate. Data analysis was conducted using Review Manager 5.41, and the presence of heterogeneity between studies was evaluated. The results were presented as the Mean Difference (MD) with 95% confidence intervals (CI). The significance level was set at P = 0.05. Results A total of five studies that reported outcomes using the IIEF scores were included in this analysis, which comprised a total of 175 patients who received HBOT and 178 control patients. The IIEF scores were analyzed by stratifying the studies according to the indication for HBOT or the cause of ED. In patients with post-robotic assisted laparoscopic prostatectomy (RALP)-induced ED, the analysis showed a significant Mean Difference (MD) of -4.13[-6.08, -2.18] p<0.0001 in favor of the control group. Conversely, patients who received HBOT for reasons other than ED exhibited a MD of 4.58[2.63,6.52] p<0.00001. In the group that received HBOT for pure vasculogenic ED, the MD was 10.50[9.92,11.08] in favor of HBOT. Patients with urethral strictures exhibited a MD of 4.25[2.29-6.21] favoring the HBOT intervention. Meta-analysis of these data revealed a nonsignificant difference in erectile function scores, with an MD of 3.86[-2.13, 9.86] p<0.00001. Conclusions The use of HBOT in the treatment of ED appears to be a promising approach. While further research is needed to establish the efficacy and long-term effects of this treatment, preliminary studies have shown encouraging results in terms of improving erectile function in men with vasculogenic ED. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.

Erectile function in men with COVID-19 six months after recovery

Background. Based on the results of epidemiological studies, it was found that coronavirus disease 2019 (COVID-19) affects men more often than women. Among COVID-19 complications, erectile dysfunction is considered a marker of endothelial dysfunction and one of the main factors for the development of cardiovascular diseases. Lower total and free testosterone levels are predictors of adverse prognosis in males with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Testosterone deficiency syndrome is considered an independent risk factor of cardiometabolic disorders. The purpose of the study is to investigate the state of erectile function in men who suffered from COVID-19 six months after recovery. Materials and methods. Seventy-two men suffering from COVID-19 and being treated in an infectious disease hospital were examined 6.90 ± 0.29 months after recovery. Their average age was 45.23 ± 3.01 years. The control group included 18 conditionally healthy men aged 43.18 ± 2.90 years. The state of erectile function was assessed using the International Index of Erectile Function (IIEF). The concentration of testosterone was determined by the enzyme-linked immunosorbent assay with DRG (Germany) and DiaMetra (Italy) kits. All measurements were performed on the Stat Fax 3200 analyzer. Statistical comparison of the obtained results between groups was performed according to the Student’s test. A value of p < 0.05 was considered to be signifi­cant. Results. In addition to erectile dysfunction, as evidenced by a reduced corresponding integrative indicator “erectile function” of IIEF-15 in men with COVID-19, a decrease in sexual desire was found, as well as a deterioration of sensations in the form of a decrease in ejaculation frequency and orgasmic sensations during sex contacts. The average serum level of total testosterone was 10.9 nmol/l and was significantly reduced compared to that in the control group. Analysis of individual indicators showed that testosterone level was decreased in 10 patients and was within the normal range in 13 men with COVID-19. The average serum concentration of total testosterone in the examined men after the disease was 10.73 ± 1.07 nmol/l and was significantly reduced compared to that of the control group. Conclusions. There was an erectile dysfunction in men who suffered COVID-19, it was confirmed by a probable decrease in IIEF-15 score and integrative indicators of erectile function. A significant decrease in the blood concentration of total testosterone was detected in the examined men, which may be one of the causes of erectile dysfunction. Large-scale prospective, randomized, controlled trials in patients infected with SARS-CoV-2 are needed to provide an understanding of the molecular mechanisms that cause erectile dysfunction.

The Impact of Using Donor Sperm After ICSI Failure in Severe Oligozoospermia on Male Mental Health and Erectile Function.

To analyze the mental health and erectile function status of men using sperm donor during pregnancy after ICSI failure in severe oligoasthenospermia and to provide reference for clinical implementation of more targeted psychological intervention and nursing for this group. A total of 410 sterile men who received assisted pregnancy treatment in our hospital from December 2020 to December 2022 and met the inclusion and exclusion criteria were collected as the study subjects. Among them, 68 patients with severe oligoasthenospermia who used donor assisted pregnancy after ICSI failure were used as the study group. Sixty-eight patients with severe oligoasthenospermia who continued to receive ICSI assisted pregnancy were matched by propensity score 1:1 as control group. General data questionnaire, self-rating Anxiety Scale (SAS), self-rating Depression Scale (SDS), Chinese version of perceived Stress Scale (CPSS) and International Erectile Function Index Rating Scale (IIEF-5) were used to conduct a cross-sectional investigation to compare the mental health and erectile function status of the two groups. There were statistical differences in age and occupational status between the two groups before PSM (P < 0.05), but there was no statistical significance in social demographic data between the two groups after matching (P > 0.05). The incidence of anxiety, depression, stress and erectile dysfunction (ED) in the study group was higher than that in the control group, and there were statistical differences between the two groups (P < 0.05). The use of donor sperm to assist pregnancy has a great impact on the mental health and erectile function of infertile men. Medical personnel should pay attention to the mental health and erectile function of these men, and formulate targeted measures to help these patients actively cope with infertility, so as to improve the life and marriage quality of this group and improve their mental health status.

Antioxidant Supplementation for Erectile Dysfunction: Systematic Review and Meta-Analysis of Double-Blind, Randomized, Placebo-Controlled Trials.

This meta-analysis aimed to determine the efficacy and safety of antioxidant supplementation for treating erectile dysfunction (ED). We systematically searched MEDLINE, Embase, and the Cochrane Library for double-blind, randomized, placebo-controlled trials of oral antioxidant supplementation in men with ED. Erectile function was assessed by the International Index of Erectile Function-Erectile Function domain (IIEF-EF) score. Using random-effects meta-analysis models, antioxidant and placebo groups were compared for erectile function using the mean difference in IIEF-EF score adjusted to a 6-30 scale and for side effects using the log risk ratio. The review included 23 trials of 1,583 men (median age 51 years) treated with antioxidant supplementation or placebo for a median of 12 weeks (range, 4 weeks to 6 months). Antioxidant supplementation significantly improved erectile function compared to placebo, with a mean difference of 5.5 points (95% confidence interval [CI]: 3.7 to 7.3; p<0.001) on the IIEF-EF. In meta-regression, the treatment benefit was greater in men with more severe ED (p<0.001). Side effects were uncommon, none were serious, and the frequency was comparable between antioxidant (3.8%) and placebo (2.1%) groups (log risk ratio=0.36; 95% CI: -0.24 to 0.97; p=0.24). Antioxidant supplementation appears safe and significantly improves erectile function in men with ED, particularly those with more severe symptoms. Limitations of this review included unknown long-term efficacy and safety and the inability to make specific product and dosing recommendations due to the variety of antioxidants and regimens studied.

TED (Trazodone Effectiveness in Depression): effectiveness of trazodone extended-release in subjects with unsatisfactory response to SSRIs.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used drugs to treat major depressive disorder (MDD). However, about 50% of MDD patients do not achieve treatment response to SSRIs and there is little evidence on which drugs are effective as second-line treatment in those who do not respond to SSRIs. In this work, the data of 79 patients with MDD were analyzed to evaluate the effectiveness of trazodone XR in the group of individuals treated de novo and those switched to trazodone XR after failed treatment attempt with SSRIs. The assessments were performed at baseline and weeks 2, 4, 8 and 12 using tools to evaluate the degree of: depression (Montgomery-Åsberg Depression Rating Scale, clinician and patient-rated Quick Inventory of Depressive Symptomatology - the primary endpoints of the study), therapeutic effectiveness (Clinical Global Impression Scale), anhedonia (Snaith-Hamilton Pleasure Scale), anxiety (Hamilton Anxiety Rating Scale), insomnia (Athens Insomnia Scale), psychosocial functioning (Sheehan Disability Scale) and sexual functioning (Female Sexual Function Inventory in women/International Index of Erectile Function in men). The rates of treatment response and remission were largely similar in both studied groups. The results showed that effectiveness of trazodone XR in the treatment of patients with MDD who did not respond to SSRIs administered as first-line treatment of a particular depressive episode was comparable to that noted in patients treated de novo. Furthermore, trazodone XR effectively improved depression, anxiety, insomnia, anhedonia and psychosocial functioning in both studied groups. Additionally, trazodone XR as secondline treatment improved sexual functions in male subjects previously treated with SSRIs.

Hyperbaric oxygen therapy as a treatment for erectile dysfunction: a meta-analysis.

Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the patient is exposed to 100% oxygen at a higher than atmospheric pressure. Over the past few decades, HBOT has been used to treat a variety of medical conditions. In recent times, there has been a rising curiosity regarding the potential therapeutic benefits of HBOT in the treatment of erectile dysfunction (ED). The study sought to review and meta-analyze available data regarding the use of HBOT for ED, including its potential mechanisms of action and effectiveness. We included only articles that evaluated the impact of HBOT on ED symptoms using the International Index of Erectile Function score. Prospective nonrandomized studies or randomized controlled clinical trials were included. Data extraction was performed in duplicate. Data analysis was conducted using Review Manager 5.41, and the presence of heterogeneity between studies was evaluated. The results were presented as the mean difference (MD) with 95% confidence interval (CI). A total of 5 studies that reported outcomes using the International Index of Erectile Function scores were included in this analysis. In patients with post-robotic-assisted laparoscopic prostatectomy-induced ED, the analysis showed a significant MD of -4.13 (95% CI, -6.08 to -2.18; P < .0001) in favor of the control group. Conversely, patients who received HBOT for reasons other than ED exhibited an MD of 4.58 (95% CI, 2.63 to 6.52; P < .00001). In the group that received HBOT for pure vasculogenic ED, the MD was 10.50 (95% CI, 9.92 to 11.08) in favor of HBOT. A meta-analysis of these data revealed a nonsignificant difference in erectile function scores, with an MD of 3.86 (95% CI, -2.13 to 9.86; P = .21). The use of HBOT in the treatment of ED appears to be a promising approach. While further research is needed to establish the efficacy and long-term effects of this treatment, preliminary studies have shown encouraging results in terms of improving erectile function in men with vasculogenic ED.

Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials.

The health benefits of regular aerobic exercise are well established, although there is limited high-quality evidence regarding its impact on erectile function. To determine the effect of aerobic exercise on erectile function in men and to identify factors that may influence this effect. This systematic review and meta-analysis included randomized controlled trials that evaluated the effects of aerobic exercise on erectile function via the Erectile Function domain of the International Index of Erectile Function (IIEF-EF). The mean difference in IIEF-EF scores between the aerobic exercise and nonexercising control groups was estimated by a random-effects meta-analysis. Meta-regression was used to evaluate the association of moderator variables on meta-analysis results. The IIEF-EF score is reported on a 6-30 scale, with higher values indicating better erectile function. Among 11 randomized controlled trials included in the analysis, aerobic exercise resulted in statistically significant improvements in IIEF-EF scores as compared with controls, with a mean difference of 2.8 points (95% CI, 1.7-3.9; P < .001) and moderate heterogeneity among studies (I2= 53%). The effect of aerobic exercise on erectile function was greater in men with lower baseline IIEF-EF scores, with improvements of 2.3, 3.3, and 4.9 points for mild, moderate, and severe erectile dysfunction, respectively (P = .02). The meta-analysis results were not influenced by publication bias or individual study effects. Health care providers should consider recommending regular aerobic exercise as a low-risk nonpharmacologic therapy for men experiencing erectile difficulties. The primary strength of this review was the generation of level 1 evidence on a topic of general interest regarding sexual health in men. However, the included studies evaluated diverse groups, which may complicate data interpretation for specific segments of the population. Regular aerobic exercise can improve the erectile function of men, particularly those with lower baseline IIEF-EF scores.

Low-intensity shockwave therapy improves baseline erectile function: a randomized sham-controlled crossover trial

Abstract Background Low-intensity shockwave therapy for erectile dysfunction is emerging as a promising treatment option. Aim This randomized sham-controlled crossover trial assessed the efficacy of low-intensity shockwave therapy in the treatment of erectile dysfunction. Methods Thirty-three participants with organic erectile dysfunction were enrolled and randomized to shockwave therapy (n = 17) or sham (n = 16). The sham group was allowed to cross over to receive shockwave therapy after 1 month. Outcomes Primary outcomes were the changes in Sexual Health Inventory for Men (SHIM) score and Erection Hardness Score at 1 month following shockwave therapy vs sham, and secondary outcomes were erectile function measurements at 1, 3, and 6 months following shockwave therapy. Results At 1 month, mean SHIM scores were significantly increased in the shockwave therapy arm as compared with the sham arm (+3.0 vs −0.7, P = .024). Participants at 6 months posttreatment (n = 33) showed a mean increase of 5.5 points vs baseline (P &amp;lt; .001), with 20 (54.6%) having an increase ≥5. Of the 25 men with an initial Erection Hardness Score &amp;lt;3, 68% improved to a score ≥3 at 6 months. When compared with baseline, the entire cohort demonstrated significant increases in erectile function outcomes at 1, 3, and 6 months after treatment. Clinical Implications In this randomized sham-controlled crossover trial, we showed that 54.6% of participants with organic erectile dysfunction met the minimal clinically important difference in SHIM scores after treatment with low-intensity shockwave therapy. Strengths and Limitations Strengths of this study include a sham-controlled group that crossed over to treatment. Limitations include a modest sample size at a single institution. Conclusions Low-intensity shockwave therapy improves erectile function in men with erectile dysfunction as compared with sham treatment, which persists even 6 months after treatment. Clinical Trial Registration ClinicalTrials.gov NCT04434352.

Long-acting glucagon-like peptide 1 receptor agonists boost erectile function in men with type 2 diabetes mellitus complaining of erectile dysfunction: A retrospective cohort study.

The pharmacological management of erectile dysfunction (ED) in type 2 diabetes (T2D) is challenging as ED has a multifactorial etiology. The therapeutic potential of certain antihyperglycemic medications, such as glucagon-like peptide 1 receptor agonists (GLP-1RAs), has yet to be entirely studied in this setting. A retrospective cohort study was conducted on 108 outpatients (median age 60 [56, 65] years) with T2D complaining of ED. Data were extracted from a database referring to patients with a 1-year follow-up on stable treatment with metformin alone (n=45) and GLP-1RAs as an add-on to metformin (n=63). Erectile function was assessed by the 5-item International Index of Erectile Function (IIEF5) at baseline and after 1 year of stable treatment . Values were compared between baseline (T0) and after 12 months of treatment (T12). ED was confirmed in all at baseline, with an IIEF5 score range between 13 and 19 points. After 12 months of treatment, glucose managementwas better in patients treated with GLP-1RAs plus metformin (HbA1c T0: 8.3±0.2 vs. HbA1c T12: 7%±0.3%, p<0.0001) than in those on metformin alone (HbA1c T0: 7±0.5vs. HbA1c T12: 7.3±0.4, p=0.0007). GLP-1RAs plus metformin over metformin alone resulted in a significant weight loss (-5.82±0.69kg, p<0.0001), reduction in waist circumference (-4.99±0.6cm, p<0.0001), improvement inHbA1c (-0.56%±0.13%, p<0.0001), and fasting plasma glucose (-25.54±3.09mg/dL, p<0.0001), increase in total (+41.41±6.11ng/dL, p<0.0001) and free (0.44±0.09 ng/dL, p<0.0001) testosterone levels, and gain in self-reported erectile function (IIEF5 score: +2.26±0.26, p<0.0001). The gain in the IIEF5 score was more relevant in patients with higher baseline IIEF5 score (estimated coefficient: 0.16±0.08, p=0.045), those having carotid stenosis (0.50±0.24, p=0.045), and showing weight loss from baseline (-0.08±0.03, p=0.013). The leading determinant of the final IIEF5 score was a 1-year treatment with GLP-1RAs plus metformin over metformin alone (2.74±0.53, p<0.0001). GLP-1RAs plus metformin over metformin alone improved ED regardless of different background characteristics of patients and partially irrespective of therapeutic targets achieved after 12 months of treatment. GLP-1RAs may have induced positive vasculature effects, resulting in improved erectile function in T2D. Due to the retrospective nature of the study, a potential cause-effect relationship between the use of GLP-1RAs plus metformin over metformin alone in improving ED cannot be verified and confirmed. Randomized clinical trials are needed to provide evidence supporting the use of GLP-1RAs for treating ED in T2D.

P-558 The importance of sexual desire for the sexual health of infertile women and men starting their fertility clinic journey

Abstract Study question Is the sexual desire of infertile women and men correlated with their intercourse frequency and sexual satisfaction? Summary answer Both partner’s sexual desire is moderately correlated to intercourse frequency and their own sexual satisfaction and weakly correlated to the sexual satisfaction of their partner. What is known already Reviews showed that infertile couples have worse sexual health than the general population. Qualitative studies explained that infertile patients feel less attractive and consider intercourse a ‘duty’, associated with failure. Fertility clinics offer diagnosis and treatments but have yet to start caring for sexual health. The Pleasure&amp;Pregnancy-programme, combining psychosexual education with communication, mindfulness and sensate focus exercises, recently proved to increase the sexual desire of infertile women pursuing natural conception. Whether improving sexual desire can be expected to increase the intercourse frequency and sexual satisfaction of women and men about to start fertility treatment had yet to be explored. Study design, size, duration A cross-sectional cohort of 140 heterosexual couples (n = 280; response rate 51%) was surveyed between 2019 and 2022. Couples filled out a package questioning their sexual health over the past four weeks at a chosen moment between their first fertility clinic consultation and the end of their diagnostic workup. This package included a questionnaire to be filled out by each partner individually and a couple questionnaire. Non-responders received were reminded. Participants/materials, setting, methods Sexual desire and satisfaction of women and men was assessed with subscales of the following valid and reliable questionnaires: Female Sexual Function Index in women (FSFI; the higher, the better) or International Index of Erectile Function in men (IIEF; the higher, the better). Intercourse frequency of couples was assessed with a sexual activity event log. Spearman rho’s correlations assessed associations between sexual desire, sexual satisfaction and coital frequency. Main results and the role of chance Responding women and men were in their early thirties and had tried to conceive naturally for 18.2 months, on average. The sexual desire of women (and of men was not correlated (r = 0.116, p = 0.178). Couples had sexual intercourse seven times per month (7.12±4.03), on average. The sexual desire of both women and men was moderately correlated to couple’s intercourse frequency (♀: r = 0.402, p &amp;lt; 0.001; ♂: r = 0.426, p &amp;lt; 0.001). The sexual desire of women was also moderately correlated to their own sexual satisfaction (r = 0.481, p &amp;lt; 0.001) and weakly correlated to the sexual satisfaction of their male partner (r = 0.270, p = 0.001). The sexual desire of men was significantly but weakly correlated to their own sexual satisfaction (r = 0.361, p &amp;lt; 0.001) and the sexual satisfaction of their female partner (r = 0.239, p = 0.005). Limitations, reasons for caution The sexual health of the included couples is currently followed-up during fertility treatment. Linear mixed models, taking account of dyads and of multiple assessments, would allow analysing the impact over time of women’s sexual desire whilst taking account of the sexual desire of her male partner and vice-versa. Wider implications of the findings Sexual desire seems important for a couple’s coital frequency and both partner’s sexual satisfaction. Examining whether a six-month sexual health programme that improves women’s sexual desire, could in the longer term improve intercourse frequency and especially sexual satisfaction or prevent the deterioration thereof would be interesting. Trial registration number not applicable

MP45-08 A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECT OF MIRABEGRON ON THE SEXUAL HEALTH OF PATIENTS WITH OVERACTIVE BLADDER (OAB) AND SEXUAL DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP45-08 A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECT OF MIRABEGRON ON THE SEXUAL HEALTH OF PATIENTS WITH OVERACTIVE BLADDER (OAB) AND SEXUAL DYSFUNCTION Vasileios Sakalis, Michael Samarinas, Konstantinos Giannitsas, Ioannis Gkialas, Nikolaos Mertziotis, Charalampos Thomas, and Apostolos Apostolidis Vasileios SakalisVasileios Sakalis More articles by this author , Michael SamarinasMichael Samarinas More articles by this author , Konstantinos GiannitsasKonstantinos Giannitsas More articles by this author , Ioannis GkialasIoannis Gkialas More articles by this author , Nikolaos MertziotisNikolaos Mertziotis More articles by this author , Charalampos ThomasCharalampos Thomas More articles by this author , and Apostolos ApostolidisApostolos Apostolidis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Published data support an effect of mirabegron on the sexual function of OAB patients further to its well-known effect on the bladder. This effect may be via activation of β3-adrenergic receptors in the corpus cavernosum tissue, causing vasodilatation independently of the NO-cGMP pathway. Other mechanisms involve a protective effect of mirabegron on pelvic endothelial dysfunction and induced vasorelaxation in both sexes’ genitalia. We systematically reviewed the literature concerning the effect of mirabegron on sexual dysfunction (SD) in both men and women. METHODS: A systematic search was performed in Embase, Medline, Cochrane and Clinical Trial databases up to September 2022. We included observational and comparative studies with primary outcome the post-treatment changes of sexual function in men or women with OAB and SD. We followed the PRISMA guidelines and Cochrane methodology. Risk of bias and confounding assessments were performed. The magnitude effect was expressed as Standard Mean Difference (SMD). RESULTS: Of 28 publications and conference abstracts selected for full-text screening, only six trials involving 259 patients (187 women and 72 men) met the inclusion criteria. None was randomized. The primary endpoint in women’s trials was the post-treatment changes in total FSFI (Female Sexual Function Index) score at 12 weeks. Meta-analysis showed a large-size treatment effect, with total FSFI score improving significantly from baseline [SMD]: -0.99 (95%CI:-1.43,-0.54, p<0.001) (Figure). Men’s trials assessed the post-treatment changes in IIEF-5 (International Index of Erectile Function) at 12 weeks. Meta-analysis showed a small-size but significant treatment effect [SMD]:-0.38 (95%CI:-0.74, -0.02, p=0.04). A phase II trial reported significant improvements in Sexual Health Inventory for Men scores at weeks 4 and 8 (p=0.0003) but not week 12. CONCLUSIONS: Current data support a significant beneficial effect of mirabegron in women suffering from SD and OAB and a smaller effect on the erectile function of men with OAB. The poor quality of included studies and the lack of randomized trials minimizes the value of these results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e624 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vasileios Sakalis More articles by this author Michael Samarinas More articles by this author Konstantinos Giannitsas More articles by this author Ioannis Gkialas More articles by this author Nikolaos Mertziotis More articles by this author Charalampos Thomas More articles by this author Apostolos Apostolidis More articles by this author Expand All Advertisement PDF downloadLoading ...

Gender difference in impact of mental health during the COVID-19 pandemic on sexual function

There is a paucity of research on the difference between men and women in the impact of mental health on sexual function during the coronavirus disease (COVID-19) pandemic. This study aims to explore sexual function changes and the effects of mental health on sexual function during the COVID-19 pandemic. The data from a self-administered online questionnaire completed by 180 healthy Korean volunteers were analyzed. During the COVID-19 pandemic, women tended to be more vulnerable than men in all subscales of the Depression, Anxiety and Stress Scale 21 (DASS-21), except for the stress subscale (p &lt; 0.001). Regarding sexual function, overall sexual function, including both the total International Index of Erectile Function-5 (IIEF-5) score and total Female Sexual Function Index (FSFI) score, was lower during the pandemic compared to before the pandemic. All subscales of DASS-21 and total DASS-21 scores were negatively correlated with total IIEF-5 and total FSFI score in men and women, respectively. On a multivariate analysis, the anxiety subscale of DASS-21 was an independent risk factor for decreased total IIEF-5 score in men (p &lt; 0.05). Mental health during the pandemic has negatively influenced sexual function in both sexes. Particularly, anxiety was a significant risk factor for decreased erectile function in men during the pandemic.