International Index Of Erectile Function Research Articles

733 Rezum Water Vapour Thermal Therapy for Treatment of Lower Urinary Tract Symptoms: A Prospective Single-Centre Analysis

Abstract Aim Benign prostatic enlargement (BPE) is a chronic disorder of the prostate with an increasing prevalence. In recent years, different minimally invasive treatment options for lower urinary tract symptoms (LUTS) secondary to BPE have been introduced. One of these technologies, Rezum, uses heat from radiofrequency generated water vapour to ablate prostatic tissue. Our study aims to investigate the safety and efficacy of Rezum through a consecutive series of patients who underwent the procedure in our department. Method A prospective study was conducted involving thirty-eight men with moderate-severe LUTS undergoing Rezum between January 2022 and February 2023. To measure efficacy, quantitative data was collected through pre-and post-operative international prostate symptom score (IPSS), quality of life score (QoL), simplified international index of erectile function (IIEF-5) checklists, and uroflowmetry to measure maximum flow rate (Qmax) and post-void residual (PVR). Patients were followed up to determine if there had been any side effects. Results The mean number of Rezum injections was 3.8 to each lateral lobe, and 0.81 to the median lobe. The results show a significant improvement in IPSS (24.1 to 9.8), QoL (4.8 to 2.0), and Qmax (10.4 to 16.8). There was no reduction in erectile function with the IIEF-5 actually slightly increasing (13.4 to 15.2). Conclusions Our single-centre prospective analysis shows that Rezum is a safe and effective minimally invasive treatment option for men with troublesome LUTS secondary to BPE. Rezum is a promising technology that could be offered to patients who wish to preserve their sexual function and discontinue their BPE medications.

Prevalence of Sexual Dysfunction among Psoriatic Male Patients

Abstract Background psoriasis is a recurring, cutaneous-articular, chronic inflammatory disease, resulting from immune and proliferative changes that affect the skin and mucosa. The worldwide incidence is 1-3% and the majority of the patients also have emotional difficulties like anxiety, depression, and sexual dysfunction. These issues along with the extent of body surface area affected have an impact on the quality of life, in particular, the sexual life, all aspects of sexual function were negatively affected by the disease process. Aim of the Work to evaluate the prevalence of sexual dysfunction among psoriatic male patients and the role of depression on sexual dysfunction. Patients and Methods the study included 60 male psoriatic patients (married sexually active with no genital abnormalities, malignancy, chronic diseases such as pulmonary, hepatic, renal, hematological, neurologic, psychosis, and similar psychiatric disorders, and not on medications that interfere with erectile function). All patients were subjected to the following: Full medical history taking, local examination of the genitalia, dermatological examination, sexual function evaluation using the Arabic version of IIEF (the international index of erectile function questionnaire) which is a validated questionnaire applied to all cases, and psychiatric evaluation using the Arabic version of Hence Hamilton Depression rating scale (HAM-D) to determine the patient’s level of depression. Results The study revealed a high prevalence of ED (86.7%) and depression (65%) among psoriatic male patients, the ED was statistically significantly affected by the severity, duration of the disease, and genital affection. Also, there was a significant correlation between ED, metabolic parameters, and depression with a significant P value. Conclusion there is a high prevalence of sexual dysfunction and depression among psoriatic male patients. Screening of sexual dysfunction among psoriatic male patients using the IIEF, depression using HAM-D, and metabolic risk factors is recommended for a better quality of life.

P-488 The importance of identifying and addressing sexual functioning in couples with unexplained infertility

Abstract Study question How is the sexual functioning of newly diagnosed unexplained infertile couples and which factors are associated? Summary answer At least 25% of couples are at risk of sexual dysfunction. Sexual functioning is associated with age, infertility duration, sperm quality, personal and relational wellbeing. What is known already A large proportion of unexplained infertile couples have the ability to conceive naturally over time. Sexual functioning is important for natural conception rates, but infertility is associated with reduced sexual functioning. Surprisingly, sexual functioning and its risk-factors are still understudied in unexplained infertility. Knowing the risk factors for reduced sexual functioning would enable fertility specialists to timely diagnose, prevent or treat sexual dysfunction, and in this way improve natural conception rates. The current literature is mainly based on individual-level data, neglecting the fact that observations, such as sexual functioning, arising from couples are not independent. Study design, size, duration Cross-sectional digital survey data and medical chart factors, which also served as the baseline assessment of a randomized controlled trial (Pleasure&Pregnancy, trial registration number NTR5709), were subjected to a dyadic analysis followed by linear regression. A total of 700 heterosexual couples recently diagnosed with unexplained infertility in secondary or tertiary fertility clinics were addressed between 2016 and 2021. Participants/materials, setting, methods Heterosexual couples (female age 18-38 year) with unexplained infertility and who were able to have coitus were eligible. Sexual functioning was assessed with the Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF). Determinants included demographic, lifestyle and diagnostic and wellbeing factors as assessed with the Hospital Anxiety and Depression Scale (HADS) and the Revised Dyadic Adjustment Scale (R-DAS). B represents the impact on sexual functioning when a factor changes 1 unit. Main results and the role of chance A total of 581 (83%) women and 478 (68%) men filled out questionnaires. Survey data and medical chart factors were available for 451 couples. About one in four women (24.3%) and one in fourteen men (7.3%) were at risk of respectively female sexual dysfunction and erectile dysfunction after fertility work-up. Couples had a mean coital frequency of 7 times per month (SD 2.7). Higher female and male sexual desire (B: 0.04, p<0.01 and B: 0.02, p<0.02) and satisfaction (B: 0.03, p<0.01 and B: 0.06, p<0.01), but not orgasm were significantly associated with increased coital frequency. Own age (B: -0.64), anxiety (B: -9.47), depression (B: -7.61) and relationship distress (B: -8.97), and partners’ relationship distress (B: -5.08) and total motility sperm count (B: -4.88) were associated with lower female sexual functioning. Own age (B: -0.17), anxiety (B: -5.03), depression (B: -3.65), relationship distress (B: -5.77), and partners’ age (B: -0.46) and relationship distress (B: -3.14) and couples’ duration of infertility (B: -0.24) were associated with lower male sexual functioning. Limitations, reasons for caution The study is prone to selection bias given the inclusion of couples seeking medical help, consenting to a RCT and were having coitus. Not all previous identified determinants of sexual functioning were studied due to factors as missing data, low case numbers or not being assessed in the Pleasure&Pregnancy RCT. Wider implications of the findings Clinicians advising couples with unexplained infertility to continue natural conception, need to be aware that at least 25% of couples are at risk of sexual dysfunction. Clinicians should consider risk factors of reduced sexual functioning, take a sexual anamnesis and advice sexual counselling and treatment if indicated. Trial registration number Baseline assessment of RCT (Pleasure&Pregnancy) with trial registration number NTR5709

Renal Transplantation Enhances the Sildenafil Citrate Effectiveness in Patients with Erectile Dysfunction. A Single-Center Perspective

ObjectiveTo assess the efficacy and safety of Sildenafil citrate in the treatment of ED in (HD) compared to post-RT patients. Patients and methodsA concurrent cohort prospective study to evaluate the efficacy of Sildenafil in the treatment of ED in 24 HD patients (Group A) and 13 patients with persistent ED one-year post-RT (Group B). The initial dose of Sildenafil was 25 mg, increased to 50 mg if there is an adequate response. An Arabic-translated International Index of Erectile Function (IIEF) questionnaire was completed one week before and after Sildenafil treatment. An IIEF erectile function score of 26 or an improvement of at least 10 points for the total IIEF score was considered a favorable response to Sildenafil. ResultsGroup A included 22 patients with a mean age of 47.32 ± 7.013 years, whereas Group B included 13 patients with a mean age of 56.87 ± 9.612 years. The overall efficacy rate of Sildenafil was 40.9% and 76.9% in groups A and B, respectively. The post-treatment IIEF5-15 score increased from 11.1 ± 5.99 to 12.5 ± 6.41 (p = .458) and from 11.82 ± 7.534 to 21.91 ± 5.700 (p = .002) in groups A and B, respectively. In both groups, the duration of HD had no impact on ED improvement except in the post-RT non-responder subgroup. Hypertension, gastrointestinal symptoms, and flushing were both groups' most common side effects. ConclusionRT could enhance the response to sildenafil in treating patients with ED. The outcome is better in younger post-RT patients with moderate and severe erectile dysfunction and shorter dialysis duration.

It is not the best option to perform transurethral enucleation of the prostate immediately after biopsy in patients with histological inflammation.

This study seeks to investigate the impact of histopathological evidence of histological prostatic inflammation (PI) on the surgical outcomes of patients with benign prostatic hyperplasia (BPH) undergoing transurethral bipolar enucleation of the prostate (BiLEP) after biopsy. We conducted a prospective study in which data were collected from 112 patients with BPH who underwent BiLEP immediately after prostate biopsy at the Department of Urology in our hospital between October 2020 and October 2023. This cohort included 52 patients with histopathological prostatic inflammation (BPH + PI group) and 60 patients with simple BPH (BPH group). Baseline characteristics, surgical details, International Prostate Symptom Score (IPSS), quality of life (QoL), post-void residual volume (PVR), maximum flow rate (Qmax), International Index of Erectile Function-5 (IIEF-5), postoperative pathology results, and surgical complications were compared between the two groups. The study findings indicate that in patients with BPH who underwent BiLEP, various parameters in the BPH + PI group including operation time, intraoperative flushing volume, hemoglobin drop value, postoperative white blood cells, postoperative C-reactive protein, and average pain score at 3 days postoperatively were significantly higher compared to those in the BPH group (p < 0.01). In addition, the IPSS and IIEF-5 scores of the BPH + PI group were significantly worse before surgery and at 2 weeks postoperatively compared to the BPH group (p < 0.01); however, no significant differences were observed between the two groups at 1 and 3 months postoperatively (p > 0.05). At 2 weeks postoperatively, the BPH + PI group exhibited significantly worse outcomes in terms of QoL, PVR, and Qmax compared to the BPH group (p < 0.01). However, there were no statistically significant differences between the two groups at 1 and 3 months postoperatively (p > 0.05). The incidence rates of postoperative complications, such as fever, prostatic capsule perforation, urinary tract irritation, bladder spasm, acute epididymitis, urinary tract infection, and urethral stricture, were higher in the BPH + PI group compared to the BPH group (p < 0.05). Nevertheless, there was no significant difference in the overall complication rates between the two groups (p > 0.05). There were no statistically significant differences observed between the two groups in postoperative irrigation volume, extubation time, hospitalization time, proportion of secondary operations, proportion of bladder injury, and proportion of urinary incontinence (p > 0.05). However, the proportion of reported prostate cancer after surgery in the BPH + PI group was significantly higher than that in the BPH group (p < 0.05). Histopathological prostatic inflammation does not have a significant impact on the long-term efficacy of BiLEP surgery immediately after biopsy. However, it does prolong surgery time, increase surgery-related complications, and influence short-term surgical outcomes and patient treatment experience. Therefore, it may be advisable to administer a course of anti-inflammatory treatment before performing BiLEP in such patients. Nevertheless, further high-quality studies are necessary to validate this approach.

Prospective, randomized, placebo-controlled, two-arm study to evaluate the efficacy of coadministration of garlic as a hydrogen sulfide donor and tadalafil in patients with erectile dysfunction not responding to tadalafil alone - A pilot study.

The objective is to evaluate the efficacy of coadministration of garlic (as a hydrogen sulfide [H2S] donor) and tadalafil for patients with ED using a placebo-controlled, prospective, randomized, two-arm pilot study in patients responding poorly to tadalafil alone. The patients with complaints of ED (with normal penile Doppler) who failed to maintain sustained improvement in erectile function with tadalafil were recruited after excluding those with comorbidities. The study sample was randomized into two groups. Group A received garlic 5 g twice a day orally and Group B received a placebo twice daily orally for 4 weeks. Both groups continued tadalafil 5 mg in the night for 4 weeks. Their erectile function was assessed at the beginning and at the end of 4 weeks using the International Index of Erectile Function (IIEF-EF), erectile function domain and compared. A value of P ≤ 0.05 was considered statistically significant. Nineteen patients in Group A (mean age 37.5 ± 10.6 years) and 16 patients in Group B (mean age 39.6 ± 9.6 years) participated in the pilot study conducted from May 2022 to August 2022. The participants treated with garlic (as an H2S donor) as a coadministrant had statistically significant improvement in IIEF-EF score (P ≤ 0.0001) at the end of 4 weeks compared to placebo. Garlic (as an H2S donor) as adjunctive therapy was beneficial in our study participants responding poorly to tadalafil alone.

Profound Sexual Dysfunction Among Patients with Hidradenitis Suppurativa: A Cross-sectional Study.

Sexual health, a critical aspect of overall well-being, is often compromised in individuals with chronic disorders. Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that mainly affects intertriginous areas, potentially impacting sexual health as a result of its specific symptoms and psychosocial burden. This cross-sectional study utilized data from the EpiCAi project, focusing on 199 patients with HS. Participants completed digital questionnaires assessing sexual health via sex-specific instruments: the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men, alongside different psychosocial scales. The disease severity was assessed using the Hurley stage and the Lesion Identification Scheme for Acne Inversa (LISAI). The majority of the participants reported impaired sexual health, with significant clinical sexual dysfunctions noted in 71.8% of women (FSFI score < 26) and erectile dysfunction in 63.8% of men. Sexual dysfunction was associated with several factors, including age, and marital status. Psychosocial factors, notably depression and quality of life, showed strong correlations with sexual health outcomes. Notably, women over 40 and those treated with biologics reported more severe dysfunction, while among men, employment status significantly influenced sexual health. HS profoundly affects the sexual health of both male and female patients, with significant impacts on their quality of life and psychological well-being. The findings underscore the necessity for healthcare providers to address sexual health proactively in the management of HS, considering both physical symptoms and psychosocial impacts. This holistic approach is essential for improving patient outcomes and overall quality of life. German Register for Clinical Trials, identifier DRKS00025315.

Erectile dysfunction in cardiovascular patients: A prospective study of the eNOS gene T‐786C, G894T, and INTRON variable number of the tandem repeat functional interaction

AbstractBackgroundCardiovascular disease induces erectile dysfunction modulated by endothelial nitric oxide synthase enzyme and an impaired ejection fraction that restricts penis vascular congestion. However, the mechanisms regulating endothelial dysfunction are not understood.ObjectivesExploring the functional impact of endothelial nitric oxide synthase genetic polymorphisms on erectile dysfunction and drug therapy optimization in high‐risk cardiovascular disease patients.Materials and methodsPatients with erectile dysfunction symptoms and candidates for andrology therapy were included (n = 112). Clinical data and endothelial nitric oxide synthase rs1799983 (G894T) and rs2070744 (T‐786C), genotyped by fluorescence polarization assays, were registered. The 27‐bp variable number of the tandem repeat polymorphism in intron 4 (intron4b/a) was analyzed by polymerase chain reaction‐restriction fragment length polymorphism. Association analyses were run with the R‐3.2.0 software.ResultsA significant association between endothelial nitric oxide synthase 786‐TT (p = 0.005) and the aa/ac of intron 4 variable number of the tandem repeat (p = 0.02) with higher erectile dysfunction susceptibility was observed in cardiovascular disease patients (60 ± 9 years, 66% severe erectile dysfunction, 56% ejection fraction). After 3‐months of phosphodiesterase type 5 inhibitors, erectile dysfunction (International Index of Erectile Function, 50 ± 16 scores, the International Index of Erectile Function‐Erectile Function 21 ± 10 scores, p &lt; 0.001) and sexual quality of life (modified Sexual Life Quality Questionnaire 55 ± 23 scores, p &lt; 0.001) had significantly improved. The cardiovascular ejection fraction was influenced positively with better sexual quality of life (0.1941), and also in the endothelial nitric oxide synthase G894‐T allele (p = 0.076) carriers, which could merit future analyses. Erectile dysfunction was present as the primary clinical manifestation in 62% of cases, with cardiovascular disease occurring concurrently. Only former smokers and obese subjects debuted prior to cardiovascular disease than to erectile dysfunction.ConclusionsOur study provides comprehensive insights into the functional interaction linking endothelial nitric oxide synthase gene polymorphisms, erectile function, and ejection fraction in high‐risk cardiovascular disease patients. Future therapeutic strategies could target endothelial nitric oxide synthase activity by including lifestyle changes and epigenetic modulations.

Long-Term Water Vapor Thermal Therapy Outcomes Across a Broad Range of Prostate Volumes.

Water vapor thermal therapy (WVTT) is a minimally invasive therapy designed to treat lower urinary tract symptoms associated with benign prostatic hyperplasia. Long-term outcomes with large (>80 cc) and small (<30 cc) prostate volumes (PVs) remain limited. We report 48-month outcomes for a multiethnic cohort of WVTT-treated men, stratified by PV. In this single-center retrospective study, patients were stratified by PV: < 30 cc, 30 to 80 cc, or > 80 cc. Outcome measures, including International Prostate Symptom Score, quality of life, International Index of Erectile Function, medication usage, and adverse events, were analyzed at baseline and at 1-, 3-, 6-, 12-, 24-, 36-, and/or 48-month follow-up. Two hundred fifty-two patients met inclusion; 35 (13.9%) had PVs < 30 cc, 196 (77.8%) had PVs 30 to 80 cc, and 21 (8.3%) had PVs > 80 cc. Most patients were Asian (33.7%) or non-Hispanic Black (29.4%). International Prostate Symptom Score and quality of life improved in all cohorts from baseline at all follow-ups (all P < .05), with no differences between cohorts. International Index of Erectile Function-Orgasmic Function and -Erectile Function domains improved in 30 to 80 cc patients at 48 months. Alpha blocker and/or 5-alpha reductase inhibitor usage decreased at all follow-ups in < 30 cc and 30 to 80 cc patients and remained durable to only 6 months for > 80 cc patients. No significant differences in adverse events or reoperation rates were observed between cohorts. Our study suggests WVTT to be efficacious, durable, and safe in managing lower urinary tract symptoms across PVs, although PV > 80 cc patients may require benign prostatic hyperplasia medication at long-term follow-up. Further research is desired to clarify WVTT's role regarding sexual function and in treating men with larger PVs.

The Effect of the Combination of Ginseng, Tribulus Terrestris, and L-arginine on the Sexual Performance of Men with Erectile Dysfunction: a randomized, double-blind, parallel, and placebo-controlled clinical trial.

Nitric oxide is the most important mediator of penile erection after the onset of sexual excitement. It activates cyclic guanosine monophosphate (cGMP), increasing penile blood flow. Most pharmaceutical medications prevent enzyme phosphodiesterase type 5 (PDE-5) from breaking down cGMP, thus keeping its level high. However, due to the adverse effects of pharmacological therapies, herbal drugs that improve sexual function have gained attention recently. This study aimed to investigate the combined effects of ginseng, Tribulus terrestris, and L-arginine amino acid on the sexual performance of individuals with erectile dysfunction (ED) using the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire. Over three months, 98 men with erectile dysfunction were randomly assigned to receive either 500 mg of herbal supplements or placebo pills. Each herbal tablet contained 100 mg of protodioscin, 35 mg of ginsenosides, and 250 mg of L-arginine. The results showed that the changes in the average scores of ILEF-5 within each group before and after the intervention indicated that all parameters related to the improvement of sexual function in patients with erectile dysfunction improved in the herbal treatment group (p < 0.001). The herbal group significantly improved IIEF-5 scores in non-diabetics (p < 0.05). However, there was no significant difference in the changes of IIEF-5 scores between the two intervention and control groups in diabetic patients. In conclusion, ginseng, Tribulus terrestris, and L-arginine have properties that increase energy and strengthen sexual function, making them suitable for patients with sexual disorders.

Effect of different physical activities on erectile dysfunction in adult men not receiving phosphodiesterase-5 inhibitors therapy: A systematic review and meta-analysis.

Erectile dysfunction (ED) is prevalent not only among older males but also in younger. The physical activity has been considered a potential protective factor against ED. However, there is a lack of comprehensive research on the impact of exercise interventions specifically on ED patients. This study aimed to assess the effectiveness of the physical activity in addressing ED symptoms among adult males, without the use of the phosphodiesterase-5 inhibitors (PDE5i) therapy. Additionally, subgroup analysis was performed to evaluate the effects of different exercise modes. Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search. A registered protocol is available at PROSPERO (CRD42023441717). Our search spanned PubMed, Web of Science, Embase, and Cochrane Library, with data collection ending on 11 April 2024. The Cochrane Risk of Bias tool was applied by two independent authors to assess randomized controlled trial (RCT) quality. The primary endpoint was determined as the International Index of Erectile Function (IIEF) scores. A total of seven RCTs were included. Utilizing a random-effects model, the estimated standardized mean difference (SMD) was 0.69 (95% confidence interval [CI] 0.37 to 1.02, p<0.0001) for the overall impact of the physical activity. Subgroup analysis revealed SMDs of 0.81 (95% CI 0.56 to 1.06; p<0.00001) for aerobic training alone. However, no significant improvement was observed with pelvic floor muscle training (PFMT) (SMD 0.03; 95% CI -0.68 to 0.75; p=0.93) and a combination of aerobic and resistance training (SMD 0.84; 95% CI -0.41 to 2.09; p=0.19) CONCLUSION: The findings of this study highlight a significant improvement in the erectile function following exercise interventions for adult men with ED, who are not receiving the PDE5i therapy, especially in conducting aerobic training alone. However, PFMT and a combination of aerobic and resistance training did not show significant improvements in erectile function from this study.

Long-term functional outcomes and predictors of efficacy in thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH): a retrospective observational study.

Benign prostatic hyperplasia (BPH) is a common urological condition affecting aging men worldwide. Among the treatment options available for BPH, transurethral resection of the prostate (TURP) is the gold-standard invasive intervention. To reduce the TURP-related non-negligible morbidity, loss-of-ejaculation rate, hospitalization, blood loss and catheterization time several laser techniques have been developed, such as the Thulium Laser Enucleation of the Prostate (ThuLEP). To investigate the efficacy outcomes of the ThuLEP as a treatment option for benign prostatic hyperplasia (BPH) we performed a retrospective observational study at Moriggia Pelascini Hospital (Como, Italy) between January 2015 and September 2018. We included 265 patients who underwent ThuLEP at a specific hospital between defined dates. Data on various parameters, including post-void residue volume, peak urinary flow rate (Qmax), International Prostate Symptom Score (IPSS) for urinary symptoms, IPSS Quality of Life (QoL) score, and International Index of Erectile Function (IIEF) score for erectile dysfunction, were collected at baseline and follow-up. The analysis revealed significant improvements in voiding efficiency, urinary flow, urinary symptoms, quality of life, and erectile function following ThuLEP. Furthermore, certain baseline characteristics, such as post-void residue, peak urinary flow rate, age, prostate volume, and aspirin usage, were found to influence treatment outcomes. Despite the study's limitations, these findings contribute to understanding ThuLEP's effectiveness in managing BPH and can aid in making informed clinical decisions for patient care. Prospective studies with longer follow-up periods are recommended to validate and extend these results.

Sexual desire and erotic fantasies questionnaire: development and validation of the sexual desire scale (SDEF1).

The evolution in conceptualization of sexual desire has stimulated many attempts to measure it. However measures able to assess multiple expressions of desire in all sexual identities are still lacking. The main aim of the present study was to test the psychometric properties of the Sexual Desire and Erotic Fantasies questionnaire - Part 1 Sexual Desire (SDEF1), developed as a sex-positive measure of different sexual desire expressions. The SDEF1 was assessed in 1773 participants from the Italian general population (1105 women, 645 men, and 23 other genders; ranged between 18-78 years old, mean age 29.31 ± 10.35) on an online survey, together with the Sexual Desire Inventory - 2, the International Index of Erectile Function, the Female Sexual Function Index, and the Marlowe-Crowne Social Desirability Scale-Short Form. Results support a factorial structure of six dimensions, including 28 items and accounting for 58.11% of the total variance: sexual desire, negative feelings to sexual desire, autoerotic desire, regular partner desire, attractive person desire, and responsive desire. The confirmatory factorial analysis showed satisfactory indexes (RMSEA = 0.042 [90% CI = 0.039-0.045]; GFI = 0.97; NFI = .96; and CFI = 0.97). Regression coefficients ranged from 0.39 to 0.94 and were all statistically significant (p < 0.001). The SDEF1 showed good psychometric properties such as internal reliability, construct, and discriminant validity, and to differentiate women and men with and without sexual difficulties. Men reported significantly higher levels of desire than women in all areas except for desire for a regular partner, were no gender difference was detected. Desire for autoerotic activity was the factor accounting for more variance explained among genders (11.7%). The SDEF1 could be a useful measure to assess different areas of sexual desire and its use could be recommended for clinical and research purposes.

The Association Between Atypical Masturbation and Male Sexual Dysfunction: A Study Based on Men in Heterosexual Relationships.

We aimed to establish the prevalence of atypical masturbation in the general population and explore the association between atypical masturbation and male sexual dysfunction in heterosexual males. Atypical masturbation refers to stimulation significantly distinct from that encountered during partnered sexual activity. We posted questionnaires that contained the abridged International Index of Erectile Function (IIEF-6) and the premature ejaculation diagnostic tool on social media in China. We collected 2743 valid questionnaires from December 9, 2020, to April 18, 2021. We found that the prevalence of atypical masturbation in the general population was 10.97%. Men with atypical masturbation had lower IIEF-6 scores and higher rates of erectile dysfunction (ED) than men with typical masturbation. The prevalence of premature ejaculation and estimated intravaginal ejaculatory latency time were not significantly different among men with different patterns of masturbation. Our study demonstrated that atypical masturbation is associated with ED, and a clinician dealing with sexual issues should inquire more fully about masturbation patterns than has been done to date.

Comparison of erectile and ejaculatory functional outcomes between unilateral and bilateral cavernosal rupture in penile fractures

This study aimed to compare the erectile and ejaculatory functional outcomes of unilateral and bilateral ruptures of the corpus cavernosum in penile fractures. Sixty patients’ data were analyzed retrospectively between June 2020 and January 2023. The patients were divided into two groups based on the affected corpus cavernosum (unilateral and bilateral). Preoperative and postoperative 3rd-, 6th-, and 12th-month self-estimated intravaginal-ejaculation-latency-time (IELT), and international index of erectile function-erectile function (IIEF-EF) scores as well as the presence of urethral injury were compared. Bilateral corpus cavernosum fractures were detected in 18.3% of the patients. The IIEF-EF scores of both groups at 3rd-, 6th-, and 12th-month were found to be significantly lower than the preoperative scores (unilateral group:24.1 ± 2.7 vs 23.2 ± 3.5 and 23.3 ± 3.4, respectively, p = 0.011 and 0.014, respectively; bilateral group: 24 ± 1.9 vs 23 ± 1.8 and 23.2 ± 1.5, respectively, p = 0.027 and 0.047, respectively). No significant difference was found between the preoperative and the postoperative 12th month IIEF-EF scores in either group (unilateral group: 24.1 ± 2.7 vs 23.4 ± 3.6, p = 0.207;bilateral group:24 ± 1.9 vs 23.2 ± 1.5, p = 0.057). The self-estimated IELTs of both groups at the postoperative 3rd, 6th, and 12th months demonstrated a significant increase from the preoperative values (unilateral group: 221.6 ± 81.8 vs 252 ± 94.6, 256.5 ± 97.6, and 250.5 ± 104.8, respectively, p < 0.001; bilateral group:241.8 ± 61.6 vs 278.1 ± 55.4, 281.8 ± 56.1, and 283.6 ± 54.2, respectively, p = 0.041, 0.030, and 0.047, respectively). The changes in self-estimated IELTs and IIEF-EF scores between the preoperative period and the postoperative 3rd, 6th, and 12th-months were compared, and no statistical difference was found between patients with unilateral and bilateral corpus cavernosum fractures (p > 0.05). In conclusion, no significant difference in erectile function was found in either group at the 12-month follow-up, and the self-estimated IELTs were found to be prolonged in both groups. Furthermore, no difference was noted between the groups at any follow-up. To explain the effects of unilateral and bilateral injuries on erectile and ejaculatory functions, further studies with a larger-number of patients are necessary.

Type 1 diabetes mellitus and sperm quality: A case-control study.

The potential impact of diabetes mellitus type 1 (DM1) on male fertility is currently poorly defined. Hyperglycaemia and insulin deficiency may affect spermatogenesis. Some evidence suggests that men with DM1 have a significant reduction in progressive sperm motility, sperm morphology and semen volume, without significant changes in sperm concentration and count, but definite data are lacking. To evaluate the impact of DM1 on clinical parameters related to male fertility and semen analysis. We compared a court of 42 male DM1 patients with 43 nondiabetic subjects overlapping in age and remaining clinical data in an observational case-control study. All subjects underwent a comprehensive andrological reproductive evaluation, including medical history, physical examination, and semen analysis. We collected biochemical data in all patients with DM1, while diabetic patients with any alteration in semen parameters underwent sperm culture and scrotal ultrasound. In addition, all men completed the IIEF-5 questionnaire (International Index of Erectile Function-5) and the AMS (Aging Male Symptom score) questionnaire. Patients with DM1 had a higher prevalence of infertility, erectile dysfunction and worse semen parameters compared with controls. In particular, semen volume, total sperm count, and total and progressive sperm motility were significantly lower (p<0.001, p=0.003, p=0.048, and p=0.022 respectively). In addition, the rate of semen anti-sperm antibody positivity, the AMS score and FSH levels were higher. Several mechanisms may contribute to these semen alterations in DM1 patients, such as oxidative damage to spermatogenesis, seminal infections and pelvic neurological changes. These data suggest that patients with DM1 should be counselled from an andrological-reproductive point of view.

Effects of Abstinence from Opioid on Sexual Functioning in Men with Opioid Use Disorder: An Observational Study

Objective: Sexual dysfunction amongst persons with opioid use disorder (OUD) is quite prevalent. Research about the effects of abstinence from opioids on sexual functioning is scarce. The aim of this study is to assess the sexual functioning among men with OUD and examine the effects of abstinence from opioids on sexual functioning. Methods: An observational study was conducted at a tertiary-level multi-specialty public-funded hospital in northern India. A total of 50 men with OUD underwent a self-report–based assessment of sexual functioning using the International Index of Erectile Function (IIEF-15). Five sub-domains of IIEF-15 (i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) were assessed at baseline, two weeks and eight weeks of abstinence from opioids. Results: A total of 44 participants out of 50 reported significant dysfunction. Most of them reported dysfunction in the domains of overall satisfaction (88%, n = 44) and sexual desire (72%, n = 36). After eight weeks of abstinence from opioids, 10 participants out of 44 reported improvement on mean assessment scores. The improvement was noted as follows: erectile function (8%), orgasmic function (2%), sexual desire (8%), intercourse satisfaction (8%) and overall satisfaction (16%) as compared to baseline. There was significant improvement in the subdomain of sexual desire ( p value .05) over the course of eight weeks of abstinence compared to baseline. Conclusion: Abstinence from opioids leads to improvement in sexual functioning over a period of eight weeks of abstinence in men with OUD.

Urinary and sexual function after robotic and laparoscopic rectal cancer surgery: a systematic review and meta-analysis.

The purpose of the study was to compare the protective effects of robotic rectal cancer surgery (RRCS) and laparoscopic rectal cancer surgery (LRCS) on urinary and sexual function of patients. We conducted a systematic search in the PubMed, Web of Science, Cochrane Library, and Embase for studies comparing the impact of RRCS and LRCS on urinary function and sexual function. The International Prostate Symptom Score (IPSS), the five-item version of the International Index of Erectile Function (IIEF-5) and the Female Sexual Function Index(FSFI) were used to evaluate the urinary function and sexual function of patients. A total of 13 studies comprising 1964 patients were included in this meta-analysis, including 3 randomized controlled trials, 5 retrospective cohort studies, 3 prospective cohort studies, and 2 propensity score-matched studies. Nine hundred and fifty-nine patients underwent RRCS and 1005 patients underwent LRCS. Statistical analysis of the IPSS scores indicated urinary function was significantly better in the RRCS group than in the LRCS group at 3, 6 and 12months postoperatively [mean difference (MD), -1.06, 95% CI -1.85 to -0.28; and MD, -0.96, 95% CI -1.60 to -0.32; and MD, -1.09, 95% CI -1.72 to -0.46]. Statistical analysis of the IIEF-5 scores indicated male sexual function was significantly better in the RRCS group than in the LRCS group at 3, 6 and 12months postoperatively (MD, 1.76, 95% CI 0.80 to 2.72; and MD, 1.83, 95% CI 0.34 to 3.33; and MD, 1.05, 95% CI 0.09 to 2.01). Statistical analysis of the FSFI scores indicated female sexual function was significantly better in the RRCS group than in the LRCS group at 6 and 12months postoperatively (MD, 2.86; 95% CI 1.38 to 4.35; and MD, 4.19; 95% CI 1.85 to 6.54). RRCS is more favorable than LRCS in preserving the urinary and sexual function of patients with rectal cancer.

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.

Unilateral Post-Chemotherapy Robot-Assisted Retroperitoneal Lymph Node Dissection for Stage II Non-Seminomatous Germ Cell Tumors: Sexual and Reproductive Outcomes.

We aimed to report sexual and reproductive outcomes following post-chemotherapy robot-assisted retroperitoneal unilateral lymph node dissection (PC-rRPLND) for non-seminomatous germ cell tumors (NSGCTs) at a high-volume cancer center. We collected records regarding sexual and reproductive outcomes of patients undergoing unilateral PC-rRPLND for stage II NSGCTs from January 2018 to November 2021. Preoperative and postoperative (at 12 months) ejaculatory function as well as erectile function, based on the International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS), were assessed. Only patients with a pre-operative IIEF-5 of ≥22 and EHS of ≥3 were included in this analysis. Overall, 22 patients undergoing unilateral PC-rRPLND met the inclusion criteria. Of these, seven (31.8%) patients presented an andrological disorder of any type after PC-rRPLND. Specifically, retrograde ejaculation was present in three (13.6%) patients and hypospermia was present in one (4.5%) patient. Moreover, three (13.6%) patients yielded erectile dysfunction (IIEF-5 < 22 and/or EHS < 3). Lastly, two (9.1%) succeeded in naturally conceiving a child after PC-rRPLND. Retrograde ejaculation is confirmed to be one of the most common complications of PC-rRPLND. Moreover, a non-negligible number of patients experience erectile dysfunction.