High Prevalence Of Erectile Dysfunction Research Articles

Abnormal cytokine profile in patients with obstructive sleep apnea-hypopnea syndrome and erectile dysfunction.

Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) show a high prevalence of erectile dysfunction (ED). Although the underlying pathogenesis is still unknown, endothelial dysfunction, induced by inflammatory cytokines, chemokines, and adhesion molecules, has been proposed as a possible mechanism. The aim of this study was to assess whether OSAHS is associated with activation of the inflammatory cytokine system in patients with ED compared to the matched OSAHS patients with normal sexual function. Thirty-one patients with severe OSAHS and ED were included. Fifteen patients with severe OSAHS and without ED served as controls. Serum concentrations of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-a), interleukin-6 (IL-6), interleukin-8 (IL-8), and adiponectin were measured after the diagnostic polysomnography. We found that hsCRP levels were significantly elevated in OSAHS patients with ED compared to controls. Similarly, TNF-a levels, IL-6, and IL-8 were elevated in OSAHS patients with ED compared to controls. Serum adiponectin levels were lower in OSAHS-ED patients, but the difference did not reach statistical significance. The presence of ED in patients with severe OSAHS is associated with elevated levels of inflammatory markers, underlining a possible involvement of endothelial dysfunction in the pathogenesis of ED.

The SUBITO-DE study: sexual dysfunction in newly diagnosed type 2 diabetes male patients.

No data on the prevalence of erectile dysfunction (ED) in subjects with newly diagnosed Type 2 diabetes mellitus (T2DM) are currently available. The aim of the present study was to estimate the prevalence of ED and its associated causes in a sample of male patients with recently diagnosed DM (<24 months) attending a diabetes care center. The study comprised two phases: a cross-sectional analysis and a longitudinal reassessment of the data collected during the first phase. During the first phase, 1503 subjects (mean age 58.7±8.9 yr) from 27 centers were interviewed: 666 (43.3%) reported experiencing ED, 499 of which (mean age 58.8±8.8 yr) agreed to participate in the study (final enrolment rate, 33.3%). Concurrent morbidities were hypertension (55.3%), dyslipidemia (39.5%), and coronary heart disease (7.8%); chronic complications were neuropathy (8.9%), nephropathy (12.6%) and retinopathy (7.6%) in about one third of the sample at enrolment. Overall, about 20% of the patients reported having used ED drugs, but more than 50% had abandoned therapy because of the drug's ineffectiveness or high cost. The prevalence of hypogonadism was 46.9% (total testosterone level, 3.5 ng/ml). Some 20% of patients reported symptoms suggestive of depression. The present study provides data showing a high prevalence of ED, hypogonadism and depressive symptoms among male patients with newly diagnosed T2DM. Further analysis of the data will elucidate the specific determinants of such conditions and their longitudinal significance.

The Global Online Sexuality Survey (GOSS): The United States of America in 2011. Chapter I: Erectile Dysfunction Among English‐Speakers

The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, based on validated questionnaires and applying age adjustment to the World Standard Population (WSP) by the World Health Organization. In 2010, the first report of GOSS came from the Middle East, describing an erectile dysfunction (ED) prevalence rate of 47%. This report studies the prevalence rate of ED in the United States as of 2011-2012 and evaluates risk factors for ED. Prevalence of ED. GOSS was randomly deployed to English-speaking male web surfers in the United States via paid advertising on Facebook, comprising 146 questions including the abbreviated 5-item International Index of Erectile Function. Two thousand twenty-two males participated; with a mean age was 52.38 years ± 14.5. Prevalence of ED was 37.7%, adjusted to 33.7% according to WSP, comparable across ethnic groups. The following risk factors were associated with higher risk for ED: diabetes mellitus, hypertension with and without antihypertensive treatment, coronary heart disease, obesity (defined by body mass index), difficult micturition, subjectively reported depression, interpersonal distress, subjectively reported impotence, in addition to novel factors such as subjectively reported premature ejaculation (PE) and concerns over genital size (not a smaller penis per se), low libido, and irregular coitus. Frequency of smoking and alcohol were not associated with higher prevalence of ED, although duration of smoking was. Adjusted to WSP, prevalence rate of ED in the United States of America is 33.7% in the year 2011, in contrast to the adjusted prevalence in the Middle East (47%). Most of the classical risk factors for ED play the same role in the United States and the World, including diabetes, hypertension, and aging. Concerns over genital size and PE are emerging risk factors for ED.

PDEI‐5 for Erectile Dysfunction: A Potential Role in Seizure Susceptibility

There is a high prevalence of erectile dysfunction (ED) in men with epilepsy; however, few studies have been conducted concerning the treatment of ED in this neurological group. The main purpose of this review is to highlight the influence of phosphodiesterase type 5 inhibitor (PDEI-5) for ED on seizure susceptibility. All available online articles with information pertaining to PDEI-5 and seizure susceptibility were included in this review. The main outcome assessed demonstrated the intriguing role of PDEI-5 and its metabolites on seizure susceptibility. Case reports in men without epilepsy described seizure occurrence and electrophysiological changes following sildenafil, tadalafil, or vardenafil treatment. Consistent with these findings, preclinical studies suggested a proconvulsant effect of PDEI-5 on models of seizure induction. Evidence suggests an influence of PDEI-5 on seizure susceptibility in humans. In addition, preclinical studies have demonstrated the role of nitric oxide metabolites in the facilitation of paroxysmal phenomenon. Although there are many causes of seizures, medical professionals should be aware of the possible influence of PDEI-5 on seizure susceptibility. Further investigation by physicians and scientists is required to improve our understanding of this important topic.

Penile Arterial Waveform Analyzing System for Early Identification of Young Adults with High Risk of Erectile Dysfunction

High prevalence of erectile dysfunction in young adults has raised much concern regarding early identification of risk factors for timely intervention. This study aimed at identifying young males at risk through a novel penile arterial waveform analyzing system. Between July 2009 and December 2010, 30 young adult volunteers of age 18 to 29 without known history of vascular diseases or erectile dysfunction were recruited. Basic demographic and anthropometric characteristics (i.e., age, body weight, body height, body mass index, waist circumference) were recorded. Blood samples were obtained for determining levels of testosterone, glycosylated hemoglobin, triglyceride, fasting sugar, low- and high-density lipoproteins (HDL). Data obtained from visual sexual stimulation (VSS) RigiScan and the penile arterial waveform amplitude (PAWA) ratios were compared in terms of their correlations with anthropometric and serum biochemical parameters using Pearson's correlation analysis. PAWA ratios were found to correlate with Rigidity (tip and base) (r = 0.425, P = 0.019 and r = 0.664, P < 0.001, respectively). Significant associations of PAWA ratios were noted not only with serum testosterone level but also with risk factors for metabolic and cardiovascular diseases including total triglyceride, HDL, age, waist circumference, body mass index, and diastolic blood pressure. However, VSS RigiScan failed in identifying significant correlations with HDL, age, and diastolic blood pressure. Not only could the penile waveform analyzing system assess penile endothelial function in young adults, but the results also showed significant associations with their serum testosterone levels and metabolic parameters. The findings suggest that PAWA ratio may serve as an indicator for early identification and treatment of young adults at risk of erectile dysfunction.

Association of Erectile Dysfunction with Atopic Dermatitis: A Population‐Based Case‐Control Study

Some studies have highlighted the high prevalence of erectile dysfunction (ED) in patients with dermatological diseases such as psoriasis, chronic hand eczema, and systemic sclerosis. However, to date, there is still no study that has explored the relationship between ED and atopic dermatitis (AD). Using a population-based data set, this case-control study aimed to examine the association of ED with prior AD by comparing the risk of prior AD between patients with ED and matched controls in Taiwan. This study used administrative claims data from the Taiwan National Health Insurance program. We identified 3,997 patients with newly diagnosed ED as cases and randomly selected 19,985 subjects without a history of ED as controls. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence interval (CI) for previously diagnosed AD between cases and controls. The prevalence and risk of having been previously diagnosed with AD between cases and controls were calculated. Of the 23,982 sampled subjects, 1,758 (7.3%) had been previously diagnosed with AD; it was found among 425 (10.6%) cases and among 1,333 (6.7%) controls (P<0.001). Conditional logistic regression analysis demonstrated that cases were more likely to have prior AD than controls (OR=1.60, 95% CI=1.42-1.80, P<0.001) after adjusting for monthly income, geographic location, urbanization level, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome. There was an association between ED and prior AD. We suggest that clinicians should be more attentive to sexual complaints from patients with AD.

A case‐control study on the association between chronic prostatitis/chronic pelvic pain syndrome and erectile dysfunction

What's known on the subject? and What does the study add? In recent years, a number of studies have reported a high prevalence of erectile dysfunction (ED) among patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Several studies have reported that the prevalence of ED ranges from 15.0 to 40.5% in men in China with CP/CPPS; however, the previous studies focusing on the prevalence of ED among patients with CP/CPPS all neglected to explore the magnitude of this association. Our study found an association between ED and previously diagnosed CP/CPPS. The odds of previous CP/CPPS were 3.62 times greater for cases than for controls, after adjusting for patient socio-demographic characteristics, comorbidities, obesity, and alcohol abuse/alcohol dependence syndrome. To examine the association between erectile dysfunction (ED) and a previous diagnosis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) using a population-based dataset. The data for this case-control study was obtained from the National Health Insurance database. A total of 3194 males, who were ≥18 years of age when they first received a diagnosis of ED, were identified and 15 970 controls were randomly selected. The prevalence and risk of CP/CPPS among cases and controls were calculated by using conditional logistic regression analysis. In total, 667 (3.5%) of the 19 164 sampled subjects had been diagnosed with CP/CPPS before the index date; CP/CPPS was found in 276 (8.6%) cases and in 391 (2.5%) controls (P < 0.001). Regression analysis indicated that cases were more likely to have had previous CP/CPPS (odd ratio 3.62, 95% confidence interval 3.07-4.26) after adjusting for patient monthly income, geographical location and urbanization level, as well as hypertension, diabetes, coronary heart disease, renal disease, obesity and alcohol abuse/alcohol dependence syndrome status, when compared with controls. We conclude that there was an association between ED and having been previously diagnosed with CP/CPPS. Urologists should be alert to the association between CP/CPPS and ED, and assess the erectile function of patients suffering from CP/CPPS.

Hypogonadism and low testosterone levels as a side effect of methadone and buprenorphine.

Dear Editor The article is an animal study which addresses an important clinical issue i.e. hypogonadism and low testosterone levels as a side effect of methadone and buprenorphine (1). This is not an uncommon side effect which we see in patients receiving long term opioid maintenance treatment. Since methadone has been in use since the 1960s, clinicians became aware of this problem and it is usually addressed and treated as needed. On the contrary, buprenorphine has been available for less than a decade. Therefore there is little information available about this possible side effect for patients on buprenorphine. A clinical trial (2) compared methadone to buprenorphine regarding their effect on Erectile Dysfunction (ED) and hormone levels. They found that men on Methadone Maintenance Treatment (MMT), but not Buprenorphine Maintenance Treatment (BMT), had high prevalence of ED, related to hypogonadism and depression. However, this study is limited by the small sample size. Another study (3) showed that patients treated with buprenorphine had a significantly higher testosterone level (P < 0.0001) and a significantly lower frequency of sexual dysfunction (P < 0.0001) compared with patients treated with methadone. Again this study was limited by the small sample size. A case series (4) reported hypogonadism in 10 patients receiving BMT without comparing it to methadone. The pharmacological profile of buprenorphine is different than methadone. Buprenorphine is a partial mu receptor agonist (5) and not a full agonist like methadone. This could be associated with reduced suppression of the central Luteinizing Hormone (LH) compared to methadone and consequently less impact on the testosterone level. Most of the available data did favor buprenorphine over methadone in regard to their effects on hypogonadism by utilizing hormonal levels. The current study has the advantage of using histopathological samples of the rat testicles to confirm the relationship between the hypogonadism and low testosterone level in this population. While this is an animal study, it adds to the knowledge that is currently available. This study may open the door to investigate this side effect at a different level. Future studies need to examine the direct relationship between opioid agonist treatment and testicular atrophy as the possible reason for hypogonadism in this population. There is a need for more studies to investigate this side effect.

Factores relacionados con la presencia de disfunción eréctil en pacientes con síndrome de apnea obstructiva del sueño

Background and objectiveObstructive sleep apnea (OSA) syndrome can contribute to the development of erectile dysfunction (ED) through multiple mechanisms. The aim was to identify factors influencing the presence of ED in these patients. Patients and methodsCross sectional study in men diagnosed with OSA by polysomnography. We obtained information about demographic variables, apnea-hypopnea index (AHI), comorbidity, blood pressure, drugs, Epworth Sleepiness Scale, physical examination, electrocardiogram, ankle-brachial index and blood and urine analysis. The presence of ED was assessed by questionnaire IIEF-5. ResultsWe included 142 patients, mean age was 53 (11) years. The prevalence of ED was 69%. We found significant differences in AHI between patients with mild and severe ED (41 [21] vs 63 [18], P=.023). ED was associated with hypertension (odds ratio [OR]=3.56 [1.64-7.72]), hypercholesterolemia (OR=7.19 [2.39-21.68]), diabetes mellitus type 2 (OR=3.07 [1.02-9.48]) and ischemic heart disease (OR=1.51 [1.33-1.70]); and treatment with antihypertensive (OR=4.05 [1.76-9.31)], lipid-lowering drugs (OR=9.71 [2.2-22.72]), anti-diabetic drugs (OR=3.21 [0.69-14.89]), antiplatelet and anticoagulant agents (OR=6.44 [1.45-28.64]). After logistic regression analysis, only age (OR=1.11 [1.05-1.16]) and hypercholesterolemia (OR=4.87 [1.49-15.96]) were associated with ED. ConclusionsPatients with OSA have a high prevalence of ED, mainly in severe OSA. Factors influencing the presence of ED in patients with OSA are primarily age and hypercholesterolemia. Other factors that may be related include hypertension, poor metabolic control, ischemic heart disease, and treatment with antihypertensive, lipid-lowering and anti-diabetic drugs.

A pilot study of sexual health in patients with Ménière's disease

Introduction and objectivesMénière's disease (MD) is a chronic disorder of the inner ear affecting health-related quality of life in 85% of patients. Although different studies have evaluated the impact of MD on quality of life, sexual health has not been investigated in these patients. The aim of this study was to assess sexual health in patients with MD. Material and methodsA cross-sectional pilot study was carried out using the general health instrument SF-36, the Dizziness Handicap Inventory Short Form (DHI-S) and two specific questionnaires on sexual functioning, the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. A statistical analysis of domains of the instruments was performed to compare the score obtained to reference values, and correlation coefficients were calculated to determine the association among different instruments. The level of significance accepted was P<.05. ResultsForty-eight individuals (26 women and 22 men) with a mean age of 55 and a lowmedium culture level were studied. Men showed a high prevalence of erectile dysfunction, twice the national reference values; women had alterations in the sexual satisfaction and pain domains. In both situations, sexual function disorders were dependent upon the SF-36 emotional domains. ConclusionsEmotional problems associated with Ménière's disease may be associated with sexual function disorders, including sexual desire in women and erectile dysfunction in men.

Prevalence of Erectile Dysfunction in Systolic Heart Failure Patients in a Developing Country: Tbilisi, Georgia, Eastern Europe

In the past decade, there has been an increasing amount of published information regarding erectile dysfunction (ED) and heart failure (HF) in economically advanced, westernized populations. However, there is a paucity of data regarding ED and HF in developing countries. The country of Georgia is categorized as a lower-middle-income country (LMIC) with an emerging and developing economy. To examine the prevalence of ED in patients with HF from a developing and LMIC and assess the association with depression. We conducted an observational, cross-sectional study that included male patients 18 years of age or older with an ejection fraction ≤40% by echocardiogram in a heart failure disease management program in Tbilisi, Georgia. The Sexual Health Inventory for Men (SHIM) survey was used to categorize men according to degree of ED. Baseline clinical characteristics known to be associated with ED, such as New York Heart Association functional classification, were also documented. The SHIM survey and the nine-question Patient Health Questionnaire. The prevalence of ED was found to be 61.7%. Patients with ED were generally older, had more peripheral vascular disease, and had greater levels of depression than those without ED. There is a high prevalence of ED in patients with HF living in Tbilisi, Georgia. In comparison to previously published data on HF populations, our Georgian population showed lesser degrees of ED. More research is needed to better explain the causality for lower prevalence of ED, but explanations may include lower degrees of diabetes and aspects of treatment such as beta-blocker medication. Health care providers in LMICs should screen all of their male HF patients for ED and provide appropriate therapy.

Estudio piloto de la salud sexual en pacientes con enfermedad de Ménière

Introduction and objectives Ménière's disease (MD) is a chronic disorder of the inner ear affecting health-related quality of life in 85% of patients. Although different studies have evaluated the impact of MD on quality of life, sexual health has not been investigated in these patients. The aim of this study was to assess sexual health in patients with MD. Material and methods A cross-sectional pilot study was carried out using the general health instrument SF-36, the Dizziness Handicap Inventory Short Form (DHI-S) and two specific questionnaires on sexual functioning, the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. A statistical analysis of domains of the instruments was performed to compare the score obtained to reference values, and correlation coefficients were calculated to determine the association among different instruments. The level of significance accepted was p<0.05. Results Forty-eight individuals (26 women and 22 men) with a mean age of 55 and a low-medium culture level were studied. Men showed a high prevalence of erectile dysfunction, twice the national reference values; women had alterations in the sexual satisfaction and pain domains. In both situations, sexual function disorders were dependent upon the SF-36 emotional domains. Conclusions Emotional problems associated with Ménière's disease may be associated with sexual function disorders, including sexual desire in women and erectile dysfunction in men.

Prevalence of aging male sexual dysfunction in Beijing: the result from a community-based cross-sectional survey of BPC-BPH stndy group

Objective To investigate the prevalence of aging male sexual dysfunction in Beijing.Methods A cross-sectional study was performed based on community of Beijing in men aged over 50 years old.The International Index of Erectile Function-5(IIEF-5),Brief Male Sexual Function Inventory for Urology(Orleary 1995)were recorded and analyzed.Results 1644 subjects were enrolled and the mean age was 64.5 years(range 50-93 years).The mean score of IIEF-5 was 9.4±8.6.The prevalence of erectile dysfunction(ED),defined as IIEF-5 between 0-21,was 90.45%.The incidence of reduction of sexual desire and defective ejaculation was 60.04%and 38.81%,respectively.There was positive correlation between the prevalence of ED,reduction of sexual desire,defective ejaculation and age.Conclusions The incidence of ED,reduction of sexual desire and defective ejaculation are positively correlated with age.Compared with high prevalence of ED,the incidences of sexual desire and defective ejaculation are lower. Key words: Sexual dysfunctions; Erectile dysfunction; Prevalence

Impact of Benign Prostatic Hyperplasia Surgery on Erectile Function

Aim: We evaluate the prevalence of erectile dysfunction (ED) prior to surgery for benign prostatic hyperplasia (BPH) and changes produced after surgical intervention. Patients and Methods: This prospective study included 128 patients treated surgically for BPH. The prevalence of ED was determined before and after surgery according to the International Index of Erectile Function (IIEF). The influence of different clinical variables on erectile function (EF) improvement or deterioration after surgery was determined using uni- and multivariate analyses. Results: Mean IIEF score before surgery was 20.5 ± 7.6. Overall, ED was absent in 32% of patients, mild in 42%, moderate in 13.3%, and severe in 12.5%. Mean IIEF score following surgery was 21.5 ± 7.4 (p = n.s.). After surgery EF improved in 26.6% (34/128) of patients and worsened in 18.8% (24/128) (p < 0.05). Analysing the subset of patients with presurgical ED, 39% reported improvement and 21.1% reported worsening of EF postoperatively. None of the variables analyzed showed a significant relationship with improvement or worsening of EF. Only age was related to worsening EF in the subgroup of non-ED patients. Conclusions: There is a high prevalence of ED amongst candidates for BPH surgery. Although the risk of worsening EF exists postsurgically, an important percentage of ED patients will improve.

Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors

To determine the prevalence of erectile dysfunction in a cohort of HIV-infected men in a stable clinical state, the effect of exposure to antiretroviral therapy on sexual dysfunction and to identify the risk factors. This is a cross-sectional, observational study. HIV-infected men without hepatitis C virus coinfection were included if they were antiretroviral therapy-naive (naive group), on current treatment with an enhanced protease inhibitor (protease inhibitor group) or on current treatment with two to three nucleoside reverse transcriptase inhibitors along with one nonnucleoside reverse transcriptase inhibitor and never having received treatment with protease inhibitor (nonnucleoside reverse transcriptase inhibitor group). Erectile dysfunction was defined as an ejection fraction of 25 or less (International Index of Erectile Function-15). Ninety patients were included, with an age of 42 +/- 8.2 years and CD4 cell count of 465 cells/microl [P25-75 361-676]: 18.9% in Centers for Disease Control and Prevention class C and 72.2% with undetectable viral load. Seventy-six patients (84.4%) were receiving antiretroviral therapy, 39 (43.3%) in the protease inhibitor group. The prevalence of lipodystrophy was 31.5%. Forty-seven (53.4%) patients had an erectile dysfunction. Multivariate logistic regression analysis confirmed that there was an independent association between the patients' age (per decade; odds ratio 2.2, 95% confidence interval 1.04-4.5, P = 0.04) and greater duration of exposure to protease inhibitor (per year; odds ratio 1.6, 95% confidence interval 1.12-2.4, P = 0.01). Older age, depression and lipodystrophy, combined with the duration of exposure to protease inhibitor, determined a lower score on various sexual dysfunction domains (P < 0.05). There is a high prevalence of erectile dysfunction in HIV-infected men, with age and the duration of exposure to protease inhibitor being the only identifiable risk factors.

Mechanisms of obesity and related pathologies: Androgen deficiency and endothelial dysfunction may be the link between obesity and erectile dysfunction

Obesity is associated with a high prevalence of erectile dysfunction; however, the pathophysiological link between obesity and erectile dysfunction remains poorly understood. In this minireview, we have attempted to evaluate the existing literature pertaining to obesity and erectile dysfunction to determine whether a common pathophysiological link exists. Visceral obesity is associated with increased inflammatory responses, which contribute to endothelial dysfunction. Furthermore, obesity is also associated with reduced plasma testosterone levels, which contributes to hypogonadism and increases the risk of vascular pathology. Endothelial dysfunction and androgen deficiency have previously been linked to the pathophysiological mechanisms of erectile dysfunction. The underlying pathophysiological mechanisms of endothelial dysfunction and testosterone deficiency include penile vascular insufficiency as a result of the loss of nitric oxide synthase expression and activity and the loss of tissue compliance, resulting in reduced hemodynamic properties. Recent progress in the field of sexual medicine has recognized the impact of vascular disease and hypogonadism on the management of patients with erectile dysfunction. We suggest that visceral obesity, a component of the metabolic syndrome, adversely affects endothelial function and testosterone levels, contributing to hypogandism and erectile dysfunction. Thus, clinical screening for the risk of erectile dysfunction in obese patients should include the assessment of waist circumference, testosterone levels, body mass index and physical inactivity.

Prévalence de la dysfonction érectile chez les patients consultant en urologie : l’enquête ENJEU (Enquête nationale de type 1 Jour sur la prévalence de la dysfonction Érectile chez des patients consultant en urologie)

The objective of this survey was to describe medical reasons disclosed by men over 18 years old when visiting an urologist, to estimate the prevalence of male sexual dysfunction (MSD) including erectile dysfunction (ED) and to describe treatment options for ED.This survey was performed, with Urology French Association (AFU) partnership, in 150 urological clinics, sample representative of urologists in France regarding age, geographical distribution and practice. The survey was proposed to all adults' men consulting a participating urologist the defined day (Tuesday the 19th of June 2007 or an imminent day). A total of 1848 (92.5%) patients agreed to participate; analysis was performed on 1740 patients. Information related to urological disorders, sexual dysfunctions, their treatment and their impact on the patient's life were gathered by a patient auto-questionnaire. Erectile dysfunction was assessed through the single question of John B. McKinlay.Among patients (mean age 63+/-14 years), 68% (IC95%=[65.2%; 70.7%]) had ED (44% severe); 25% were treated (of which 2/3 with IPDE5 alone or in association). Male sexual dysfunction was the first reason for visiting urologists (14%) following prostatic diseases (62%). About 60% of the patients had already talked about their ED to a physician, who was an urologist in 44.6% of cases. The perspective of living the rest of their life with this trouble was "unacceptable" for 21.1% of patients with ED and "fairly acceptable" for 34.4%.This first survey in French urologists' community emphasizes the high prevalence male sexual dysfunctions for inpatients visiting their urologists. Despite declared urologists' interest for male sexual dysfunction, the discrepancy between the high prevalence of ED and the low rate of patients consulting for this condition probably explains the low rate of patients using treatments.

Association of coronary artery disease, erectile dysfunction, and endothelial nitric oxide synthase polymorphisms

The purpose of this study was to determine the relationship between erectile dysfunction (ED), coronary artery disease (CAD), and T(-786)C and intron 4 a/b endothelial nitric oxide synthase (eNOS) polymorphisms in 419 patients with suspected or known CAD referred for coronary angiography. The patients had a high prevalence of risk factors for both CAD and ED: hypercholesterolemia (64%), hypertension (74%), diabetes mellitus (25%), obesity (30%), and smoking (63%). Three hundred and twenty-one patients had significant coronary atherosclerosis (luminal diameter narrowing of 50% or more of at least 1 coronary artery), 41 had insignificant coronary stenoses, and 57 patients were found to have coronary arteries without the evidence of atherosclerosis. The prevalence of ED in these groups was 79%, 76%, and 67% (P = NS), respectively. As compared to patients without ED, those with ED exhibited significantly higher probability of having significant coronary atherosclerosis (69% vs 79%, P = 0.04), higher number of significant coronary stenoses (median, 1 vs 2, P = 0.004), and a higher prevalence of a triple-vessel disease (12% vs 25%, P = 0.004). We did not find any relationship between T(-786)C and intron 4 a/b polymorphisms and the manifestation of coronary atherosclerosis or the presence of ED. In conclusion, in patients with numerous cardiovascular risk factors referred for coronary angiography, there was a high prevalence of ED in patients with both the presence and the absence of coronary atherosclerosis. The coincidence of CAD and ED identified patients at increased risk of severe forms of CAD.

Erectile Dysfunction in End-Stage Liver Disease Men

In men, erectile dysfunction (ED) is an important issue. Data concerning ED in men with end-stage liver disease (ESLD) is limited, and the risk factors for ED in this population are still unknown. To determine the prevalence, timescale, and risk factors for ED in ESLD patients candidates to liver transplantation. Patients candidates for a liver transplantation were asked to participate in a mailed survey about sexual function. Among the 123 eligible men, 98 (84%) agreed to complete the questionnaire. The quality of erection was evaluated using the five-item International Index of Erectile Function (IIEF-5) score, and satisfaction for sexuality, using the patient-baseline Treatment-Satisfaction Scale (TSS) score. Other questions also focused on patient perception of changes over time. On the overall population, 28 patients (29%) were nonsexually active. Among the 70 patients who were sexually active, 52 patients (74%) had ED. Regarding the development of ED, 50% of the patients perceived that a deterioration of erectile function occurred within the six previous months. The absence of sexual activity was more frequent in hepatitis B or C patients (P = 0.02). The risk factors for ED were alcohol intake (P = 0.03), tobacco use (P = 0.03), and cardiovascular disease (P = 0.004). The significant risk factors for having a low TSS score were having viral hepatitis (P = 0.01), and cardiovascular disease (P = 0.01). Population of men with ESLD who are candidates for a liver transplantation is characterized by a high frequency of lack of sexual activity, and by a high prevalence of ED and should be targeted by interventions to improve sexual functioning. These preliminary data need further validation in prospective trial using more comprehensive questionnaires.

Managing Erectile Dysfunction in Patients With Cardiovascular Diseases: The Efficacy and Safety of Phosphodiesterase-5 Inhibitors

Patients with cardiovascular disease have a high prevalence of erectile dysfunction. Recent evidence demonstrated that erectile dysfunction is an early indication of coronary artery disease. Phosphodiesterase-5 (PDE-5) inhibitors are effective in managing erectile dysfunction due to cardiovascular disease. However, when used together with nitrates or other vasodilators such as alpha-antagonists, they may cause hypotension. Clinical studies demonstrated that in patients with stable coronary artery disease, heart failure, and hypertension controlled by medications who were not receiving nitrates, PDE-5 inhibitors were well tolerated. Therefore, it is important for clinicians to carefully evaluate each patient before initiating PDE-5 inhibitors. PDE-5 inhibitors are absolutely contraindicated with concurrent nitrate use. No PDE-5 inhibitors should be administered within 12 hours after the last nitrate dose. If a patient develops chest pain while taking PDE-5 inhibitors, nitrates should be administered only after the PDE-5 inhibitors have been washed out of the system, based on the half-life of individual agents (washed-out period for sildenafil ∽20 hours; vardenafil ∽ 24 hours; tadalafil ∽88 hours [or 3-4 days]). If symptomatic hypotension occurs, patients should be put in a Trendelenburg position. Fluid resuscitation therapy and alpha-agonists should be used to support blood pressure, if necessary. PDE-5 inhibitors have not been studied in patients with severe and unstable cardiac conditions.