Help For Erectile Dysfunction Research Articles

Spontaneous erectile function recovery among young men with erectile dysfunction taking tadalafil 5mg once a day.

Daily (once a day [OaD]) tadalafil intake is a valuable option for men favoring spontaneous over scheduled sexual intercourse. The study sought to assess the rate of and the clinical factors associated with spontaneous, medication-free erectile function (EF) recovery after discontinuation of tadalafil 5mg OaD in a cohort of young men seeking first medical help for psychogenic erectile dysfunction (ED) as their primary complaint. Data from 96 consecutive patients <50years of age seeking first medical help for ED and prescribed tadalafil 5mg OaD were analyzed. Patients completed the International Index of Erectile Function (IIEF) and underwent baseline penile color Doppler ultrasound. Follow-up involved clinical assessments or phone interviews. Spontaneous medication-free EF recovery was defined as IIEF EF domain score >22 after tadalafil discontinuation, prompting cessation of follow-up. Descriptive statistics compared tadalafil OaD responders and nonresponders. Cox regression hazard models explored the association between baseline characteristics and EF recovery risk post-drug discontinuation. Kaplan-Meier analyses estimated EF recovery probability over time. The primary outcome was EF recovery after discontinuation of tadalafil 5mg OaD. Overall, median age was 39 (interquartile range [IQR], 32-45) years. Of all, 82 (85.4%) patients achieved EF recovery after tadalafil OaD discontinuation, while 14 (14.6%) patients were identified as nonresponders. Median tadalafil usage time (from beginning to discontinuation) was 3 (IQR, 2-11) months. The most common treatment-emergent adverse event was headache in 9 (9.4%) patients. Nonresponders were older (43 [IQR, 42-45] years vs 38 [IQR, 31-44] years; P = .03), had higher body mass index (25.5 [IQR, 23.4-29.9] kg/m2 vs 23.6 [IQR, 21.8-25.9] kg/m2; P = .04), and reported lower baseline IIEF EF domain scores (12 [IQR, 7-15] vs 15 [IQR, 10-22]; P = .02) than responders. Nonresponders and responders did not differ in terms of baseline ED severity, Charlson comorbidity index, smoking, alcohol consumption, regular physical exercise, and color Doppler ultrasound parameters. Upon Cox regression analysis, younger age (hazard ratio, 0.95; 95% confidence interval, 0.92-0.99; P = .01) was associated to EF recovery, after adjusting for baseline ED severity, body mass index, smoking, and Charlson comorbidity index ≥1. The Kaplan-Meier analysis displays the probability of EF recovery over time, indicating rates of 43%, 60%, and 72% at 3-, 6-, and 12-month follow-up intervals, respectively. Tadalafil 5mg OaD is an effective short-term treatment for psychogenic ED, allowing its discontinuation after achieving a normal medication-free EF. The main limitations are the limited number of participants and the potential neglect of confounding factors. Almost 1 out of 2 young men with primary psychogenic ED who were prescribed with tadalafil 5mg OaD recovered spontaneous medication-free EF after 3months of treatment. Overall, the younger the patient was, the higher the chance there was of spontaneous EF recovery after drug discontinuation.

PDE5is-naïve versus non-naïve patients at first investigation for erectile dysfunction-findings from a long-term, real-life cross-sectional study.

Phosphodiesterase 5 inhibitors (PDE5is) represent a first-line pharmacological therapy for erectile dysfunction (ED). Men could obtain PDE5is for recreational purposes without any proper medical prescription. We aimed to analyze clinical characteristics of patients who already used any PDE5i for ED without previous formal medical prescription. Data from 2012 heterosexual, sexually active men seeking first medical help for ED at our outpatient clinic between 2005 and 2022 were analyzed. All patients were assessed with a comprehensive sexual and medical history and completed the International Index of Erectile Function (IIEF) at baseline. Comorbidities were scored with the Charlson comorbidity index (CCI). Thereof, according to exposure to any PDE5i before their first visit, patients were subdivided into: PDE5i-naïve and non-PDE5i-naïve patients. Descriptive statistics tested the sociodemographic and clinical characteristics of both groups. A logistic regression model predicted the likelihood of being PDE5i-naïve at the baseline. Linear regression analysis (LRA) estimated the likelihood of being PDE5i-naïve versus non-PDE5i-naïve over the analyzed timeframe. Lastly, local polynomial regression models graphically explored the likelihood of being PDE5i-naïve at the first clinical assessment over the analyzed timeframe, and the sensitivity analyses tested the probability of being PDE5i-naïve at baseline. Overall, 1,491 (70.9%) patients were PDE5i-naïve and 611 (29.1%) were non-PDE5i-naïve at the first assessment. PDE5is-naïve patients were younger, with a lower prevalence of CCI ≥ 1 and of normal erectile function (EF) than non-PDE5i-naïve men (all p<0.05). Multivariable logistic regression found that patients with lower BMI (OR: 0.99), higher IIEF-EF scores (OR: 1.02), lower rates of severe ED (OR: 0.94), and who had been assessed earlier throughout the study timeframe (OR: 1.27) were less likely to be PDE5i-naïve at baseline. Univariate LRA revealed that younger patients (Coeff: -0.02), with lower CCI (Coeff: -0.29) and higher alcohol intake per week (Coeff: 0.52) were more likely to be PDE5i-naïve over the analyzed timeframe. Moreover, for the same IIEF-EF score, patients with higher CCI had lower probability of being PDE5i-naïve. Self-prescription of PDE5is is an attitude presents in the general population, despite this phenomenon has decreased overtime. Current data outline the importance to keep promoting educational campaigns to promote PDE5is as effective and safe medicinal products, while avoiding their improper use.

Unrecognised orgasmic phase disorders in men presenting with new-onset erectile dysfunction-Findings from a real-life, cross-sectional study.

Orgasmic phase disorders in men worsen the burden of erectile dysfunction on sexual satisfaction. To investigate the prevalence of and predictors of unreported orgasmic phase disorder in a cohort of men looking for their first urological assessment for new-onset erectile dysfunction in a real-life setting. Data from 1107 heterosexual, sexually active men consecutively assessed for new-onset erectile dysfunction were analysed. Throughout a comprehensive medical and sexual history, all patients were asked to self-report any orgasmic phase disorder and to complete the International Index of Erectile Function and the Beck's Inventory for Depression (depressive symptoms scored as Beck's Inventory for Depression ≥11). Men self-reporting orgasmic phase disorder during the interview were excluded from further analyses. The median value of the International Index of Erectile Function-orgasmic function domain was arbitrarily used to categorise men with (International Index of Erectile Function-orgasmic function ≤5) and without unreported orgasmic phase disorder (International Index of Erectile Function-orgasmic function >5). Circulating hormones were measured in every patient. Descriptive statistics and logistic regression models were used to test the association between clinical variables and unreported orgasmic phase disorder. Of 1098 patients with non-self-reporting orgasmic phase disorder, 314 (28.6%) had International Index of Erectile Function-orgasmic function ≤5. Patients with erectile dysfunction + unreported orgasmic phase disorder were older (median [interquartile range]: 58 [44-66] years vs. 51 [40-60] years), had higher body mass index [25.8 (23.7-28.1) kg/m2 vs. 25.2 (23.3-27.4) kg/m2 ], higher prevalence of type 2 diabetes (36 [11.5%] vs. 45 [5.7%]) and lower International Index of Erectile Function-erectile function scores (6 [2-10] vs. 18 [11-24]) than men with erectile dysfunction-only (all p<0.05). Patients with erectile dysfunction + unreported orgasmic phase disorder depicted higher rates of severe erectile dysfunction (75.5%vs. 25%) and Beck's Inventory for Depression ≥11 (22.6%vs. 17.9%) (all p<0.05). In the multivariable logistic regression analysis, older age (odds ratio: 1.02) and lower International Index of Erectile Function-erectile function scores (odds ratio: 0.83) were independently associated with unreported orgasmic phase disorder (all p<0.05). Almost one in three men seeking first medical help for erectile dysfunction depicted criteria suggestive of unreported orgasmic phase disorder. Men with unreported orgasmic phase disorder were older and had higher rates of severe erectile dysfunction and concomitant depressive symptoms. These real-life findings outline the clinical relevance of a comprehensive investigation of concomitant sexual dysfunction in men only complaining of erectile dysfunction to more effectively tailor patient management.

Hyperestrogenism is associated with sexual function impairment in men-findings from a cross-sectional, real-life study.

Hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new-onset erectile dysfunction. Data from 547 men seeking first medical help for new-onset erectile dysfunction at a single andrology center were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson comorbidity index. All patients completed the International index of erectile function; the International index of erectile function-erectile function domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estradiol levels >42.6 pg/mL (Tan etal., 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and International index of erectile function domains score. Overall, 96 (17.6%) participants had serum estrogen levels suggestive of hyperestrogenism. Men with hyperestrogenism were older (median [interquartile range]: 46 [35-59] vs. 44 [31-56] years; p<0.001), had a higher rate of comorbidities (Charlson comorbidity index ≥1: 26.0% vs. 7.4%; p<0.001), and higher serum total testosterone values (5.4 [5.2-8.0] vs. 4.3 [4.1-5.7] ng/mL; p=0.01) than those with normal estradiol values. A higher prevalence of severe erectile dysfunction (135 [29.9%] vs. 47 [48.9%] men; p=0.01) and of hypogonadism (22 [4.8%] vs. 6 [6.3%] men; p=0.004) were found in men with hyperestrogenism. Serum estradiol levels were positively correlated with total testosterone levels (β = 0.26, p<0.001) but negatively correlated with International index of erectile function-orgasmic function (β = -0.24, p=0.002) and International index of erectile function-erectile function scores (β = -0.03, p<0.001). When International index of erectile function scores was used to stratify erectile dysfunction patients, hyperestrogenism (odds ratio 2.44, p=0.02) was associated with severe erectile dysfunction. One out of five men seeking first medical help for erectile dysfunction showed elevated serum estradiol values suggestive of hyperestrogenism. Hyperestrogenism was associated with health-significant comorbidities, orgasmic function impairment, and erectile dysfunction severity.

(378) Still One Out of Five Men Presenting for Erectile Dysfunction are Young than 40 years of Age: Findings of a Real-life Cross-sectional Study over Last Decade

Abstract Introduction Erectile dysfunction (ED) has been demonstrated to be reasonably prevalent among young men (≤40 yr). Objective We aimed to i) assess changes in patterns of reported ED in men ≤ 40 yr, and ii) compare the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. &amp;gt; 40 yr of age over a 8-yr period at a single academic centre. Methods Comprehensive data of 1179 patients seeking first medical help for ED and assessed by a single Sexual Medicine expert between 2013 and 2021 were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Descriptive statistics tested the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. &amp;gt; 40 yr of age. Within the two groups, multivariable linear regression models tested the association between advancing age and IIEF scores. Local polynomial regression models were applied to explore and graphically display ≤ 40 yr patients’ likelihood to report ED over the analysed time frame and to display changes of the IIEF-EF scores over increasing age between the two groups (≤ 40 yr vs. &amp;gt; 40 yr). Results Overall, median (IQR) age was 52 (41-62) yr. Median (IQR) IIEF-EF was 18 (15-22) at baseline. Of all, 268 (22.7%) were ≤ 40 yr whereas 911 (77.3%) were &amp;gt; 40 yr at baseline. Rates of severe ED according to IIEF-EF did not differ between men ≤ 40 yr and &amp;gt;40yr (60 (22.4%) vs. 155 (17%)). No significant differences were found for the IIEF domains (-IS, -OS, -SD) but IIEF-OF domains, which scored higher in younger men (9 () vs. 8 (), p=0.002). At baseline, younger patients reported less comorbidities, less active smoking, lower BMI, higher total testosterone (tT) levels than older patients (all p 40 yr, increasing age was linearly correlated with decreasing IIE-EF (all p 40 yr). Conclusions We observed that one out of five men seeking first medical help for ED at a single academic centre were younger than 40 yr. This trend has remained stable over the last 8-years, but slightly lower than the previous decade. Increasing age among younger patients is not associated with worse erectile function as oppositely occurs among patients &amp;gt; 40 yr. Disclosure No

(330) Trends of Reporting Premature Ejaculation Among Men with Erectile Dysfunction – Findings From a Real-life Cross-sectional Study

Abstract Introduction Patients with erectile dysfunction (ED) may have an increased risk to report concomitant premature ejaculation (PE) Objective We aimed to explore the trend of reporting PE across three different age groups of a homogenous cohort of men seeking first medical help for ED (&amp;lt; 40 yr, 40-60 yr, &amp;gt; 70yr) over a 16-year period at a single tertiary academic centre. Methods Complete data of 1258 men consecutively assessed for ED as primary complaint by a single Sexual Medicine expert between 2005 and 2021 were analysed. Patients were divided into three age categories: i) &amp;lt;40 years, ii) 40-69 years, and iii) ≥ 70 years. All patients were assessed with a comprehensive medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) at baseline. Between the three groups i) descriptive statistics tested the sociodemographic and clinical differences; ii) regression models tested the probability of reporting concomitant PE over time; and, iii) local polynomial regression models graphically explored the probability of reporting PE (primary/secondary) together with ED over the analysed time frame. Results Overall, median (IQR) age was 51 (40-61) years. Of all, 326 (25.9%) reported either life-long or acquired PE at time of first clinical assessment. Among the three age groups (70) there were no significant differences in terms of baseline IIEF domains. Younger patients reported higher rates of PE in respect to older ones (0.5% vs. 0.4% vs. 0.3%, p=0.001). Logistic regression analysis showed a statistically significant trend of reporting PE over the years among the &amp;lt; 40yr (OR: 1.4; 95%CI: 1.3-1.5) and 40-69yr (OR: 1.3; 95%CI: 1.2-1.4) groups respectively (all p&amp;lt;0.0001). A not significant trend was found in the ≥ 70yr group. Figure 1 graphically displays the probability of reporting PE in the whole cohort and among the three age-matched groups between 2005 and 2021. Conclusions Almost one out of four patients seeking first medical help for ED also reports to suffer from PE. The probability of reporting PE (either primary or secondary) has been exceptionally increasing over the last 15 years among young (&amp;lt;40) and middle-age (40-69) men with ED. This finding is of major clinical relevance in order to a better tailored therapeutic work-up in the real life setting. Disclosure No

(304) Relevance of Self-masturbation-related vs. Coital Erectile Function in the Real-life Management of Patients with Erectile Dysfunction

Abstract Introduction The Masturbation Erection Index (MEI) has been recently validated in the setting of the investigation of men presenting with erectile dysfunction (ED). Objective We sought to analyze the correlation between MEI and the findings of the widely used International Index for Erectile Function (IIEF) in a cross-sectional study in men seeking medical help for ED. Methods Data from the last 87 consecutive men presenting for ED at a tertiary referral centre were analyzed. All patients were asked to complete both IIEF and MEI at the same time. Complete sociodemographic and clinical data were collected. ED severity was defined according to Cappelleri’s criteria. Linear regression model tested the association between MEI, IIEF total and IIEF domains scores. Violin plot was used to display distribution of MEI scores into IIEF-EF categories. Loess curve was applied to investigate the probability of MEI to predict ED as a function of age. Results Median (interquartile range [IQR]) age at presentation was 44 (3.5-53.5) years. According to IIEF-EF scores, ED severity was: no ED in 9 (10%), mild ED in 14 (16%), mild-to-moderate ED in 19 (22%), moderate ED 12 (14%) and severe ED in 33 (38%) patients, respectively. The more severe the ED, the higher the MEI scores (Figure 1); indeed, median MEI scored 7 (3-8) in men with no ED and 19 (10-26) in men with severe ED (p&amp;lt;0.05). Of note, 16 patients (18%) depicted low MEI scores (i.e., under the median), but moderate or severe ED as for their IIEF scores. Finally, a univariable negative association between MEI scores and IIEF-overall satisfaction and IIEF-intercourse satisfaction scores was found [i.e. the higher the MEI scores, the lower the intercourse and overall sexual satisfaction (p&amp;lt;0.001)]. Although MEI decreased throughout aging, it was not significantly different in younger vs. older men with ED. Conclusions As expected, there is a strong association between IIEF and MEI scores, which does not lower with aging. Of all, one out of 5 patients presented with lower overall and intercourse satisfaction notwithstanding high MEI scores, thus outlining the clinical relevance of both investigations in the real-life setting. Disclosure No

Prevalence and predictors of unrecognised low sexual desire/interest in men with new onset erectile dysfunction: findings from a cross-sectional, real-life study.

The interrelationship between male sexual desire and erectile dysfunction (ED) has been scantly investigated. Thus, we aimed at investigating the prevalence of and the predictors of unrecognised low sexual desire/interest (uLSD/I) in a cohort of men with new onset ED. Complete data from 1587 men seeking for first medical help for ED between 2010 and 2021 were analysed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). At entrance, all patients were asked to self-report low sexual desire/interest and completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI) (depressive symptoms scored as BDI ≥ 11). The IIEF-erectile function (IIEF-EF) domain was categorised according to Cappelleri's criteria. The median value of the IIEF-sexual desire domain (IIEF-SD) was used to dichotomise men with uLSD/I along with ED (IIEF-SD < 7) vs. ED-only (IIEF-SD ≥ 7). Circulating hormones were measured in every patient. Hypogonadism was defined as total testosterone (tT) <3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and uLSD/I. Of 1197 patients not self-reporting LSD/I, 369 (30.8%) had IIEF-SD < 7. Patients with ED + uLSD/I were older [median (IQR) 54(41-63) vs. 49(36-59) years], had lower IIEF-EF [10.5(5-22) vs. 22(11-28)] but higher BDI [6(3-12) vs. 4(1-8)] and lower tT [4.3(3.2-5.7) vs. 4.8(3.2-6.3) ng/mL] compared to ED-only men (all p < 0.05). Overall, ED + uLSD/I men had higher rate of severe ED (49.9% vs. 23.9%), and of BDI ≥ 11 (30.6% vs. 18.2%) (all p < 0.05). At multivariable logistic regression analysis, lower tT (OR: 0.82), lower IIEF-EF scores (OR:0.95) and BDI ≥ 11 (OR:2.51) were independently associated with ED + uLSD/I, after accounting for age (all p < 0.05). Almost 30% of men seeking first medical help for ED-only had also uLSD/I. Men with both conditions were older, had higher rates of severe ED and more depressive symptoms. A detailed investigation of sexual desire should be always included in men self-complaining only of ED.

Prevalence and predictors of unrecognized low sexual desire in men with new onset erectile dysfunction – findings from a cross-sectional, real-life study

The interrelationship between sexual desire and erectile dysfunction (ED) has been variously investigated. We aimed to investigate the prevalence of and the predictors of unrecognized low sexual desire (LSD) in the real-life setting. Data from 1509 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. All participants self-reported the presence of LSD. Moreover, patients completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI). Depressive symptoms were defined as BDI ≥11. The median value of the IIEF-Sexual desire domain (IIEF-SD = 7) was arbitrarily used to categorize the cohort in low vs. normal SD. Hypogonadism was defined as total testosterone (tT) < 3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and unrecognized LSD. Of 1197 (79.3%) patients not self-reporting LSD, 369 (30.8%) had IIEF-SD <7. Patients with unrecognized LSD were older [median (IQR) 54 yrs (41-63) vs. 49 yrs (36-59), p<0.001], had lower IIEF-EF [10 (5-20) vs. 22 (11-28)] but higher BDI [6 (3-12) vs. 4 (1-8)] and lower tT [4.3 (3.2-5.7) vs. 4.7 (3.2-7.3) ng/ml] (all p<0.001). Overall, men with unrecognized LSD presented a higher rate of severe ED (50% vs. 24%, p<0.001), and of BDI suggestive for depressive symptoms (30.6% vs. 18.3%) and of hypogonadism (19.9% vs. 10%) (all p<0.001). At multivariable logistic regression analysis, lower tT, not suggestive for hypogonadism (OR 0.91, p=0.03), lower IIEF-EF (OR 0.94, p<0.001) and BDI suggestive for depressive symptoms (OR 1.83, p<0.001) were independent predictors of unrecognized LSD, after accounting for age. One out of three men seeking first medical help for ED showed unrecognized LSD. Men with unrecognized LSD were older, had higher rates of severe ED and depressive symptoms and lower tT values than men with normal SD. None

Premature ejaculation among men with erectile dysfunction-findings from a real-life cross-sectional study.

Concomitant sexual disorders have progressively shown increased prevalence in men at first outpatient presentation. We sought to i) estimate the prevalence of unreported premature ejaculation (PE) in a homogenous cohort of 1258 men seeking first medical help for erectile dysfunction (ED) as their primary compliant; ii) compare the baseline sociodemographic and clinical characteristics of men with only ED(ED-only) compared to those with ED and PE(ED + PE); and, iii) investigate the likelihood of detecting PE among men self-reporting only ED over a 16-year period at a single tertiary-referral centre. Descriptive statistics compared sociodemographic and clinical characteristics between ED-only patients and those with unreported concomitant primary/secondary PE(ED + PE). Logistic regression models predicted the risk of having ED + PE at baseline. Local polynomial regression models graphically explored the probability of reporting PE among ED men with ≤40 vs. 41-60 vs. >60 years over the analysed timeframe. Of all, 932 (74.1%) were ED-only and 326 (25.9%) ED + PE patients, respectively. ED + PE patients were younger, presented with fewer comorbidities, and lower rates of severe ED (all p ≤ 0.04). At multivariable logistic regression analysis, younger age (OR:0.98) and low sexual desire/interest (OR:1.54) were independently associated with ED + PE at first clinical assessment (all p = 0.03). The likelihood of detecting unreported concomitant primary/secondary PE among patients complaining of only ED at first presentation worrisomely increased among younger and middle-aged men over the last 16 years.

Primary organic versus primary psychogenic erectile dysfunction: Findings from a real-life cross-sectional study.

Erectile dysfunction aetiology has been historically identified as organic, psychogenic and mixed. To stratify and compare a cohort of patients seeking medical help for erectile dysfunction for the first time according to the newly proposed binary classification of the European Association of Urology guidelines: 'primary organic' versus 'primary psychogenic'. Complete data from 2009 consecutive patients presenting for erectile dysfunction were analysed. All patients completed the International Index of Erectile Function at baseline. According to the presence of erectile dysfunction-related risk factors indexed by the European Association of Urology Guidelines on Sexual and Reproductive Health, patients were categorised as having primary organic (≥1 risk factor) or primary psychogenic (0 risk factor) erectile dysfunction. Descriptive statistics compared the two groups. Linear regression analysis tested the association between the number of risk factors and erectile dysfunction severity. Locally estimated scatterplot smoothing method graphically explored the relationship between the number of risk factors for erectile dysfunction and the International Index of Erectile Function domain scores. Median (interquartile range) age at first presentation was 50 (39-61) years. Of all, 1632 (86.2%) and 377 (13.8%) were identified as having primary organic and primary psychogenic erectile dysfunction, respectively. Overall, 1488 (74.1%) patients were >40 years of age; in this subgroup, the most frequent risk factors were age, hypertension (29%), active smoking (42%) and alcohol intake (25.1%). Median (interquartile range) International Index of Erectile Function-erectile function score was 15 (7-22). Primary organic erectile dysfunction patients depicted lower International Index of Erectile Function-sexual desire and International Index of Erectile Function-orgasmic function scores (all p≤0.02), whilst groups did not differ in terms of International Index of Erectile Function-erectile function, International Index of Erectile Function-intercourse satisfaction and International Index of Erectile Function-overall satisfaction scores. One out of nine patients complaining of erectile dysfunction depict criteria for primary psychogenic erectile dysfunction. Erectile function severity could be as severe as patients with organic erectile dysfunction. The single-centre-based cross-sectional nature of the study, raising the possibility of selection biases, is our main limitation. One out of nine patients presenting for erectile dysfunction depict criteria suggestive for primary psychogenic erectile dysfunction in the real-life setting. Patients with primary psychogenic and primary organic erectile dysfunction have comparable erectile dysfunction severity, thus outlining the importance of a comprehensive and tailored management work-up in every patient seeking medical help for the first time.

Prevalence and predictors of unrecognized low sexual desire in men with new onset erectile dysfunction – findings from a cross-sectional, real-life study

ABSTRACT Introduction The interrelationship between male sexual desire and erectile dysfunction (ED) has been variously investigated. Objectives We aimed to investigate the prevalence of and the predictors of unrecognized low sexual desire (LSD) in a cohort of men seeking medical help for new onset ED in the real-life setting. Methods Data from 1509 men seeking first medical help for new-onset ED at a single andrology centre between 01/2010 and 01/2020 were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All participants were asked to self-report the presence of LSD. Moreover, patients completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI). Depressive symptoms were defined as BDI ≥11. The median value of the IIEF-Sexual desire domain (IIEF-SD) was used to categorize the cohort in low SD (IIEF-SD &amp;lt;7) vs. normal SD (IIEF-SD ≥7). The IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hypogonadism was defined as total testosterone (tT) &amp;lt; 3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and unrecognized LSD. Results Overall, 312 (20.7%) patients self-reported LSD and were excluded from further analyses. Of 1197 patients not self-reporting LSD, 369 (30.8%) had IIEF-SD &amp;lt;7 (arbitrarily defined as unrecognized LSD). Patients with unrecognized LSD were older [median (IQR) 54 yrs (41-63) vs. 49 yrs (36-59), p&amp;lt;0.001], had lower IIEF-EF [10 (5-20) vs. 22 (11-28)] but higher BDI [6 (3-12) vs. 4 (1-8)] and lower tT [4.3 (3.2-5.7) vs. 4.7 (3.2-7.3) ng/ml] (all p&amp;lt;0.001) than men without LSD. Overall, men with unrecognized LSD presented a higher rate of severe ED (50% vs. 24%, p&amp;lt;0.001), and of BDI suggestive for depressive symptoms (30.6% vs. 18.3%) and of hypogonadism (19.9% vs. 10%) (all p&amp;lt;0.001). At multivariable logistic regression analysis, lower tT, despite not suggestive for hypogonadism (OR 0.91, p=0.03), lower IIEF-EF (OR 0.94, p&amp;lt;0.001) and BDI suggestive for depressive symptoms (OR 1.83, p&amp;lt;0.001) were found to be independent predictors of unrecognized LSD, after accounting for age. Conclusions One out of three men seeking first medical help for ED showed unrecognized LSD according to the IIEF-SD domain scores. Men with unrecognized LSD were older, had higher rates of severe ED and depressive symptoms and lower tT values despite not suggestive for hypogonadism than men with normal SD. A detailed investigation of sexual desire should be always included in the diagnostic work-up of men with ED, in order to better tailoring patient therapeutic management. Disclosure Work supported by industry: no.

PD09-07 HYPERESTROGENISM IS ASSOCIATED WITH SEXUAL FUNCTION IMPAIRMENT IN MEN—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY

You have accessJournal of UrologyCME1 May 2022PD09-07 HYPERESTROGENISM IS ASSOCIATED WITH SEXUAL FUNCTION IMPAIRMENT IN MEN—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY Luca Boeri, Paolo Capogrosso, Giuseppe Fallara, Walter Cazzaniga, Luigi Candela, Federico Belladelli, Edoardo Pozzi, Massimiliano Raffo, Antonio Costa, Christian Corsini, Daniele Cignoli, Nicolò Schifano, Gianmarco Colandrea, Alessia d'Arma, Eugenio Ventimiglia, Rayan Matloob, Federico Dehò, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Antonio CostaAntonio Costa More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Alessia d'ArmaAlessia d'Arma More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002535.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality. We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting. METHODS: Data from 547 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF); the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri’s criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estradiol (E2) levels >42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores. RESULTS: Overall, 96 (17.6%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (35-59) vs. 44 (31-56) years; p <0.001], had more comorbidities [CCI≥1: 26.0% vs. 7.4%; p <0.001] and higher serum testosterone (TT) levels [5.4 (5.2-8.0) vs. 4.3 (4.1-5.7); p=0.01] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (49.0% vs. 29.9%; p=0.01). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (5-10), p=0.03]. Serum E2 levels were positively correlated with TT levels (rho 0.26, p <0.001), but negatively correlated with IIEF-OF (rho -0.2, p<0.01) and IIEF-EF scores (rho -0.33, p <0.001). At multivariable logistic regression analysis, hyperestrogenism (OR 2.44, p=0.02) was associated with severe ED after accounting for age, BMI, CCI and serum TT values. CONCLUSIONS: One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e179 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Walter Cazzaniga More articles by this author Luigi Candela More articles by this author Federico Belladelli More articles by this author Edoardo Pozzi More articles by this author Massimiliano Raffo More articles by this author Antonio Costa More articles by this author Christian Corsini More articles by this author Daniele Cignoli More articles by this author Nicolò Schifano More articles by this author Gianmarco Colandrea More articles by this author Alessia d'Arma More articles by this author Eugenio Ventimiglia More articles by this author Rayan Matloob More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

Hyperestrogenism is associated with sexual function impairment in men – findings from a cross-sectional, real-life study

ABSTRACT Introduction High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality. Objectives We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting. Methods Data from 481 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) and the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estrogen (E2) levels &amp;gt;42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores. Results Overall, 88 (18.3%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (34-58) vs. 44 (32-55) years; p&amp;lt;0.001], had more comorbidities [CCI≥2: 18 (20.5%) vs. 28 (7.1%); p&amp;lt;0.001] and higher serum testosterone (TT) levels [5.4 (4.2-7.3) vs. 4.3 (3.1-5.7); p=0.02] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (48.9% vs. 30%; p=0.02). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (6-10), p=0.03]. Serum E2 levels were positively correlated with TT levels (rho 0.25, p&amp;lt;0.001), but negatively correlated with IIEF-OF scores (rho -0.17, p=0.005) and IIEF-EF scores (rho -0.32, p&amp;lt;0.001) (Figure 1). At multivariable logistic regression analysis, hyperestrogenism (OR 2.37, p=0.03) was associated with severe ED after accounting for age, BMI, CCI and serum T values. Conclusions One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED. Disclosure Work supported by industry: no.

MP21-12 STILL ONE OUT OF FIVE MEN PRESENTING FOR ERECTILE DYSFUNCTION ARE YOUNG THAN 40 YEARS OF AGE: FINDINGS OF A REAL-LIFE CROSS-SECTIONAL STUDY OVER LAST DECADE

You have accessJournal of UrologyCME1 May 2022MP21-12 STILL ONE OUT OF FIVE MEN PRESENTING FOR ERECTILE DYSFUNCTION ARE YOUNG THAN 40 YEARS OF AGE: FINDINGS OF A REAL-LIFE CROSS-SECTIONAL STUDY OVER LAST DECADE Edoardo Pozzi, Paolo Capogrosso, Giuseppe Fallara, Luca Boeri, Christian Corsini, Daniele Cignoli, Massimiliano Raffo, Luigi Candela, Nicolò Schifano, Alessia d'Arma, Rayan Matloob, Federico Dehò, Vincenzo Mirone, Francesco Montorsi, and Andrea Salonia Edoardo PozziEdoardo Pozzi More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Luca BoeriLuca Boeri More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Alessia d'Arma Alessia d'Arma More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Federico DehòFederico Dehò More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002554.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) has been demonstrated to be reasonably prevalent among young men (≤40 yr). We aimed to i) assess changes in patterns of reported ED in men ≤40 yr, and ii) compare the sociodemographic and clinical characteristics of ED men ≤40 yr vs. >40 yr of age over a 8-yr period at a single academic centre. METHODS: Data of 1179 patients seeking first medical help for ED and assessed by a single Sexual Medicine expert between 2013 and 2021 were analysed. All patients completed the IIEF at baseline. Descriptive statistics tested the sociodemographic and clinical characteristics of ED men ≤ 40 yr vs. > 40 yr of age. Within the two groups, multivariable linear regression models tested the association between advancing age and IIEF scores. Local polynomial regression models were applied to explore and graphically display ≤ 40 yr patients’ likelihood to report ED over the analysed time frame and to display changes of the IIEF-EF scores over increasing age between the two groups. RESULTS: Overall, median (IQR) age was 52 (41-62) yr. Median (IQR) IIEF-EF was 18 (15-22) at baseline. Of all, 268 (22.7%) were ≤40 yr whereas 911 (77.3%) were >40 yr at baseline. Rates of severe ED according to IIEF-EF did not differ between men ≤40 yr and >40yr (60 (22.4%) vs. 155 (17%)). No significant differences were found for the IIEF domains (-IS, -OS, -SD) but IIEF-OF domains, which scored higher in younger men (9 () vs. 8 (), p=0.002). At baseline, younger patients reported less comorbidities, less active smoking, lower BMI, higher total testosterone (tT) levels than older patients (all p<0.005). At linear regression models, within the ≤ 40 yr group, increasing age was not associated with changes across all IIEF domains. In contrast, in men > 40 yr, increasing age was linearly correlated with decreasing IIE-EF (all p<0.001), after adjusting for tT, BMI, CCI, smoking and arterial hypertension. Figure 1 graphically displays a stable 8-yr temporal trend of ≤40 yr ED patients. CONCLUSIONS: One out of five men seeking first medical help for ED at a single academic centre were younger than 40 yr. This trend has remained stable over the last 8-years. Increasing age among younger patients is not associated with worse erectile function as oppositely occurs among patients > 40 yr. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e331 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edoardo Pozzi More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Luca Boeri More articles by this author Christian Corsini More articles by this author Daniele Cignoli More articles by this author Massimiliano Raffo More articles by this author Luigi Candela More articles by this author Nicolò Schifano More articles by this author Alessia d'Arma More articles by this author Rayan Matloob More articles by this author Federico Dehò More articles by this author Vincenzo Mirone More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP27-13 PREVALENCE AND PREDICTORS OF UNRECOGNIZED LOW SEXUAL DESIRE IN MEN WITH NEW ONSET ERECTILE DYSFUNCTION—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP27)1 Sep 2021MP27-13 PREVALENCE AND PREDICTORS OF UNRECOGNIZED LOW SEXUAL DESIRE IN MEN WITH NEW ONSET ERECTILE DYSFUNCTION—FINDINGS FROM A CROSS-SECTIONAL, REAL-LIFE STUDY Luca Boeri, Paolo Capogrosso, Walter Cazzaniga, Luigi Candela, Giuseppe Fallara, Edoardo Pozzi, Federico Belladelli, Nicolò Schifano, Daniele Cignoli, Gianmarco Colandrea, Massimiliano Raffo, Costantino Abbate, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Costantino AbbateCostantino Abbate More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002024.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The interrelationship between male sexual desire and erectile dysfunction (ED) has been variously investigated. We aimed to investigate the prevalence and the predictors of unrecognized low sexual desire (LSD) in a cohort of men seeking medical help for new onset ED in the real-life setting. METHODS: Data from 1509 men seeking first medical help for new-onset ED at a single andrology centre in 2010-2020 were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All participants were asked to self-report the presence of LSD and to complete the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI). Depressive symptoms were defined as BDI≥11. The median value of the IIEF-Sexual desire domain (IIEF-SD) was used to categorize the cohort in low SD (IIEF-SD<7, defined as unrecognized LSD) vs. normal SD (IIEF-SD≥7). The IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri’s criteria. Serum hormones were measured in every patient. Hypogonadism was defined as total testosterone (tT)<3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and unrecognized LSD. RESULTS: Overall, 312 (20.7%) patients self-reported LSD and were excluded from further analyses. Of 1197 patients not self-reporting LSD, 369 (30.8%) had IIEF-SD<7. Patients with unrecognized LSD were older [median (IQR) 54 yrs (41-63) vs. 49 (36-59)], had lower IIEF-EF [10 (5-20) vs. 22 (11-28)], higher BDI [6 (3-12) vs. 4 (1-8)] and lower tT [4.3 (3.2-5.7) vs. 4.7 (3.2-7.3) ng/ml] (all p<0.001) than men without LSD. Men with unrecognized LSD presented a higher rate of severe ED (50% vs. 24%, p<0.001), of BDI≥11 (30.6% vs. 18.3%) and tT<3.0ng/mL (19.9% vs. 10%) (all p<0.001). At multivariable logistic regression analysis, lower tT (OR 0.91, p=0.03), lower IIEF-EF (OR 0.94, p<0.001) and BDI≥11 (OR 1.83, p<0.001) were found to be independent predictors of unrecognized LSD, after accounting for age. CONCLUSIONS: One out of three men seeking first medical help for ED showed unrecognized LSD. Men with unrecognized LSD were older, had more severe ED and depressive symptoms and lower tT values despite not suggestive for hypogonadism than men with normal SD. Thus, a detailed investigation of sexual desire should be always included in the diagnostic work-up of men with ED. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e476-e476 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Walter Cazzaniga More articles by this author Luigi Candela More articles by this author Giuseppe Fallara More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Nicolò Schifano More articles by this author Daniele Cignoli More articles by this author Gianmarco Colandrea More articles by this author Massimiliano Raffo More articles by this author Costantino Abbate More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Loading ...

Evaluation of the Mistakes in Self-Diagnosis of Sexual Dysfunctions in 11,000 Male Outpatients: A Real-Life Study in An Andrology Clinic.

Purpose: The aim of this study was to compare the initial request for sexual consultation with the final diagnosis and to evaluate the limits of the active andrological anamnesis concerning unclassified male sexual dysfunction. Methods: In this 12-year observational retrospective study, we collected data from patients referring to an andrological outpatient clinic, evaluating the requests, perceptions, needs, and self-diagnosis at their first visit and comparing them with the final diagnosis reached after a complete clinical, laboratory, and instrumental investigation. Results: A total of 11,200 patients were evaluated. The main request of andrological consultation was erectile dysfunction (ED) (52%), followed by premature ejaculation (PE) (28%), and low sexual desire (11.5%). Among the patients seeking help for ED, about 30% were ultimately found to have a different type of dysfunction and 24% were diagnosed with an “unmet need”, which included issues not present in the current nosography nonetheless affecting sexual and relational life. Among the patients referring for PE, the final diagnosis was lifelong PE for the large majority of them, regardless of whether initially they thought to have an acquired form. Several of those who sought consultation for acquired PE were frequently found to be able to compensate for lifelong PE by a subsequent coitus or were able to induce orgasm in the partner with different modalities. Among the patients referring for low sexual desire, only 57.5% were confirmed to have it; 23% had ED and 18.5% showed a raised threshold of penile sensitivity. Conclusions: The results of this study show that the reason for consultation is frequently misleading and raise the relevance of being aware of the so-called “unmet needs” and to discuss with the patient and the couple to explore the sexual history behind the self-diagnosis. These findings also suggest the need to expand the current taxonomy of male sexual dysfunctions.

Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages?

IntroductionThe impact of erectile dysfunction (ED) on patients’ sexual satisfaction and mood profile could differ across different ages. AimTo investigate the relationship between erectile function (EF), sexual satisfaction, and mood status among patients seeking medical help for ED. MethodsData from 765 patients presenting at a single center for ED were analyzed. Patients were categorized as young (≤50 years), middle-aged (>50 and ≤65 years), and old (>65 years) individuals and completed the International Index of Erectile Function (IIEF) and the Beck’s Inventory for Depression (BDI). Main Outcome MeasuresThe IIEF overall satisfaction and intercourse satisfaction domain scores and the BDI score were used to investigate sexual life satisfaction and depressive symptoms (defined as BDI > 11) across ages and according to ED severity. Linear and logistic regression analyses assessed the relationship between satisfaction scores and the risk of depressive symptoms with age and EF. ResultsMedian (interquartile range) age at first assessment for ED was 50 (38, 59) years. Compared with older men, young and middle-aged patients showed significantly higher IIEF-OS and IIEF– Intercourse Satisfaction scores for increasing IIEF-EF scores. Older men showed no difference in terms of satisfaction scores for mild ED and normal EF status. At linear regression analysis, both IIEF-EF and age were significantly associated with sexual satisfaction (all P < .0001). The interaction term between age and EF was also significant, suggesting that the older the patients, the higher the feeling of sexual satisfaction for the same EF status (P = .004). Overall, 25% of patients reported depressive symptoms. Logistic regression analysis showed a 40% risk of depressive symptoms for patients <45 years with severe ED compared to a risk <20% for a man >65 years of age with the same EF status. Clinical ImplicationsTreating older patients with mild ED may not lead to a further improvement in sexual satisfaction as compared with younger patients with the same ED severity. Younger ED patients suffer more from depressive symptoms compared with older men, regardless of ED severity, thus supporting the need for a comprehensive psychological counseling. Strength & LimitationsThe single-center design and the lack of the assessment of the impact of ED treatment are the main limits. ConclusionsThe clinical management of ED should be tailored according to different ages: younger patients deserve to be investigated and eventually treated for depressive symptoms. Older patients should be counseled for treatment when a sexual satisfaction improvement is expected.Capogrosso P, Ventimiglia E, Boeri L, et al. Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages? J Sex Med 2019;16:999–1004.

PO-01-014 Impact of undiagnosed prediabetes on phosphodiesterase type 5 inhibitors response in men with erectile dysfunction

There is a lack of studies addressing response to PDE5i in men with prediabetes (PreDM). We assessed the response to PDE5i in men with normo-glycaemia, DM and PreDM seeking first medical help for erectile dysfunction (ED). ED patients with PreDM depicted lower rates of response to PDE5i than euglycaemic men. These Results suggest that even milder forms of glucose impairment are associated with impaired efficacy of ED therapy. However, only DM emerged as an independent predictor for impaired treatment response. Overall, 196 (56.7%), 81 (23.5%) and 69 (19.7%) patients had normo-glycaemia (=controls), PreDM and DM, respectively. Diabetic and PreDM men were older (all p<0.001), had higher BMI (all p<0.02) and CCI scores (all p<0.01) and lower total testosterone (tT) (all p<0.04) than controls. Median IIEF-EF was lower both in DM (10.0 vs. 18.0; p<0.001) and in PreDM (14.0 vs. 18.0; p<0.001) than in controls. IIEF-EF improved in all groups after treatment (all p<0.001). Controls more frequently reached significant MCID than PreDM and DM patients (65.3% vs. 22.9% vs. 11.8%). IIEF-EF scores were higher in controls than PreDM and DM men after treatment (26.0 vs. 20.0 vs. 17.5; all p<0.01). Multivariable logistic regression analysis showed that age (OR 0.96, p<0.001), baseline IIEF-EF score (OR 0.94, p<0.001), and +DM (OR 0.37, p=0.02) were independent predictors of MCID, after accounting for BMI, CCI and tT.

PO-01-015 One out of three men seeking medical help for erectile dysfunction has blood glucose levels suggestive for undiagnosed hyperglycaemia: Worrisome picture from the real-life setting

PO-01-015 One out of three men seeking medical help for erectile dysfunction has blood glucose levels suggestive for undiagnosed hyperglycaemia: Worrisome picture from the real-life setting