International Index Of Erectile Function Intercourse Satisfaction Research Articles

Effects of obsessive beliefs and anxiety on sexual function in HPV-positive men.

Our study aimed to investigate the effects of anxiety and obsessive beliefs on sexual function in men with human papillomavirus (HPV) and healthy men. Ninety HPV-positive men (mean age=32.26 ± 6.63 years) from the Urology Outpatient Clinic and 75 healthy men (mean age=33.51 ± 5.67 years) who worked in the hospital were assessed using the International Index of Erectile Function-15 (IIEF-15), Obsessive Beliefs Questionnaire-44 (OBQ), and State-Trait Anxiety Inventory (STAI) in 2023. The mean IIEF-15 scores of the patients with HPV and healthy individuals were 24.59 ± 6.14 vs. 23.16 ± 6.23 for the IIEF-erectile function; 8.30 ± 2.34 vs. 7.79 ± 1.77 for the IIEF-orgasmic function; 7.40 ± 1.73 vs. 7.23 ± 1.53 for the IIEF-sexual desire; 11.30 ± 3.38 vs. 11 ± 3.10 for the IIEF-intercourse satisfaction; and 7.62 ± 2.18 vs. 7.53 ± 2.02 for the IIEF-overall satisfaction (p > 0.05 for all). However, the mean OBQ and STAI scores of patients with HPV and healthy individuals were 46.66 ± 16.06 vs. 36.44 ± 19.25 for the OBQ-inflated responsibility/overestimation of threat (OBQ-RT); 45.91 ± 17.31 vs. 36.53 ± 19.08 for the OBQ-perfectionism/intolerance of uncertainty (OBQ-PU); 28.04 ± 12.31 vs. 23.80 ± 11.74 for the OBQ-importance of thought/control thoughts (OBQ-IC); 37.58 ± 12.06 vs. 33.59 ± 11.09 for the STAI-state anxiety (p < 0.05 for all); and 32.83 ± 8.34 vs. 33.44 ± 11.05 for the STAI-trait anxiety (p = 0.689). Our results showed that the STAI-state anxiety (β = -0.37; β = -0.32; and β = -0.43, respectively) and OBQ-IC (β = -0.57; β = -0.43; and β = -0.48, respectively) scores were the main predictors of the IIEF-erectile function, IIEF-orgasmic function, and IIEF-overall satisfaction scores in the HPV-positive group. The OBQ-RT (β = 0.46), OBQ-PU (β = -0.51) and STAI-state anxiety (β = -0.56) scores were unique predictors of the IIEF-sexual desire score, and the OBQ-RT (β = 0.41), OBQ-PU (β = -0.42), and OBQ-IC (β = -0.43) scores were the main predictors of the IIEF-intercourse satisfaction score in the HPV-positive group. However, regression models for the IIEF-15 subscales for the control group were not significant (p ˃ 0.05). Understanding the role of obsessive beliefs and anxiety in sexual dysfunction among HPV-positive men might be important for developing psychotherapeutic interventions.

(292) Impact of Urinary Incontinence on Sexual Function in Patients Presenting for Lower Urinary Tract Symptoms

Abstract Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged &amp;gt;18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Results Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p&amp;lt;0.001), IIEF-EF (rho= -0.15; p&amp;lt;0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p&amp;lt;0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI. Conclusions In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). 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

MP61-05 PREVALENCE OF ORGASMIC DYSFUNCTION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY AND ITS RELEVANCE TO THE INTERNATIONAL INDEX OF ERECTILE FUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP61-05 PREVALENCE OF ORGASMIC DYSFUNCTION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY AND ITS RELEVANCE TO THE INTERNATIONAL INDEX OF ERECTILE FUNCTION Masashi Honda, Ryutaro Shimizu, Shogo Teraoka, Ryoma Nishikawa, Noriya Yamaguchi, Hideto Iwamoto, Shuichi Morizane, Katsuya Hikita, and Atsushi Takenaka Masashi HondaMasashi Honda More articles by this author , Ryutaro ShimizuRyutaro Shimizu More articles by this author , Shogo TeraokaShogo Teraoka More articles by this author , Ryoma NishikawaRyoma Nishikawa More articles by this author , Noriya YamaguchiNoriya Yamaguchi More articles by this author , Hideto IwamotoHideto Iwamoto More articles by this author , Shuichi MorizaneShuichi Morizane More articles by this author , Katsuya HikitaKatsuya Hikita More articles by this author , and Atsushi TakenakaAtsushi Takenaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The cause of orgasmic dysfunction is not well understood, and how many and which patients undergoing radical prostatectomy, especially robot-assisted radical prostatectomy (RARP), are affected remains unclear. Moreover, relationship between post-RARP orgasmic dysfunction and erectile dysfunction has not been clarified. This study aimed to evaluate the incidence of orgasmic dysfunction in patients after RARP and identify the relevance of orgasmic dysfunction to the International Index of Erectile Function (IIEF). METHODS: We performed a single-center, cross-sectional, questionnaire-based investigation of patients who underwent RARP (n=523). Of the 523 patients, men who received neoadjuvant therapy (n=54), adjuvant therapy (n=46), or died from other causes (n=6) were excluded, leaving 417 patients for analysis. All patients were treated at our institution between 3 and 111 months prior to the start of the study. Six questions on sexual activity, orgasmic function, altered perception of orgasms, dysorgasmia, and climacturia were developed. Questionnaires about orgasmic dysfunction and IIEF were mailed with a letter inviting patients to participate in the study. The primary outcome measure was the prevalence of orgasmic dysfunction. The relationship between orgasmic dysfunction and IIEF domain scores was analyzed. RESULTS: Overall, 259 questionnaires were available for analyses. Among sexually active patients (n=145), 33 (22.8%) reported anorgasmia, 22 (15.1%) reported dysorgasmia, and 44 (30.3%) reported climacturia. The IIEF-erectile function (EF), IIEF-sexual desire (SD), IIEF-intercourse satisfaction (IS), and IIEF-overall satisfaction (OS) scores of the anorgasmia group were significantly lower than those of the non-anorgasmia group (2.33±1.63 versus 7.93±7.94, p<0.001; 3.91±2.05 versus 5.13±1.73, p<0.001; 0.39±1.09 versus 1.92±3.44, p=0.013; 3.73±1.59 versus 5.38±1.78, p<0.001). Also, the IIEF-EF, IIEF-SD, and IIEF-OS scores of the dysorgasmia group were significantly lower than those of the non-dysorgasmia group (4.36±4.86 versus 8.81±8.32, p=0.018; 4.32±1.73 versus 5.32±1.68, p=0.014; 4.46±1.65 versus 5.60±1.75, p=0.006). CONCLUSIONS: Orgasmic dysfunction is a common adverse effect of RARP. Moreover, these results indicate that anorgasmia and dysorgasmia may be associated with erectile function and may affect sexual desire and satisfaction after RARP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e854 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masashi Honda More articles by this author Ryutaro Shimizu More articles by this author Shogo Teraoka More articles by this author Ryoma Nishikawa More articles by this author Noriya Yamaguchi More articles by this author Hideto Iwamoto More articles by this author Shuichi Morizane More articles by this author Katsuya Hikita More articles by this author Atsushi Takenaka More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of urinary incontinence on sexual function in patients presenting for lower urinary tract symptoms

ABSTRACT Introduction Patients with low urinary tract symptoms (LUTS) frequently complain some sexual dysfunction and sometimes even episodes of bothersome urinary incontinence (UI). Objective We aimed to assess the relationship between UI (as measured with the ICIQ-UI-SF), and sexual disfunction (as measured with the IIEF), in men presenting with LUTS at a tertiary-referral centre. Methods In this cross-sectional study, data were retrospectively retrieved from 938 consecutive patients aged &amp;gt;18 years seeking first medical help for self-reported LUTS (i.e., all patients had IPSS≥1). All patients had a complete clinical assessment and completed the IPSS, the ICIQ-UI-SF, the OAB-q and the IIEF questionnaires. Patients were stratified into “no UI” (ICIQ-UI-SF=0), “mild UI” (ICIQ-UI-SF=1-7), “moderate UI” (ICIQ-UI-SF=8-13) or “severe UI” (ICIQ-UI-SF=14-21). ANOVA test assessed differences in baseline characteristics among these groups. Spearman correlation test was applied to evaluate the correlation between ICIQ-UI-SF and IIEF domain scores. A linear regression analyses tested putative risk factors associated with increased ICIQ-UI-SF scores. Result Of 938, 589 (63%) patients had no UI, 237 (25%) had mild UI, 76 (8%) moderate UI and 36 (4%) severe UI. There were no substantial differences in total PSA levels and uroflowmetry parameters among UI groups, whereas prostate volume, IPSS and OAB-q scores were higher as UI symptoms increased (all p≤ 0.03). A negative correlation was found between IIEF-total, IIEF-Erectile Function, IIEF-Intercourse Satisfaction and IIEF-Overall Satisfaction scores and ICIQ-UI-SF scores (i.e., the worse UI symptoms, the worse the overall sexual function (rho= -0.12; p&amp;lt;0.001), IIEF-EF (rho= -0.15; p&amp;lt;0.001), IIEF-IS (rho = -0.1; p=0.004) and IIEF-OS (rho = -0.12; p&amp;lt;0.001). Sexual desire and orgasmic function domains were not correlated with ICIQ-UI-SF. Finally, higher BMI (Coeff 0.12; 95% CI 0.03-0.32; p=0.011), diabetes (Coeff 1.76; 0.35-3.18; p=0.015) and presence of comorbidities (Coeff: 0.9; 0.06-0.1.74; p=0.035) were associated with higher ICIQ-UI-SF scores. Main limitations of the study were that ICIQ-UI-SF does not discriminate between urge or stress UI. Conclusion In patients presenting with LUTS, the presence of urinary incontinence was associated with worsening of overall sexual function (i.e., erectile function, intercourse satisfaction and overall satisfaction). Disclosure Work supported by industry: no.

Vardenafil in the Treatment of Male Erectile Dysfunction: A Systematic Review and Meta-Analysis.

We carried out this systemic review and meta-analysis of relevant randomized controlled trials to determine different dosage regimens of vardenafil in the treatment of male erectile dysfunction (ED). Using appropriate keywords, we searched PubMed, the Cochrane Library, and Embase for relevant literature before March 2020. We evaluated odds ratio (OR), weighted mean difference (WMD), and 95% confidence interval (95% CI) to assess the results of each study. We included 14 studies with a total of 3221 patients. Compared with the placebo, vardenafil significantly increased International Erectile Function Index (IIEF) overall satisfaction (WMD 3.37, 95%CI 2.02-4.71), IIEF-erectile function (WMD 7.93, 95%CI 6.00-9.85), IIEF sexual desire (WMD 0.79, 95%CI 0.24-1.35), IIEF intercourse satisfaction (WMD 5.24, 95%CI 3.35-7.13), IIEF orgasmic function (WMD 3.81, 95%CI 2.26-5.35), Sexual Encounter Profile (SEP) Q2 (WMD 26.36, 95%CI 22.95-29.77), and SEP Q3 (WMD 35.18, 95%CI 31.89-38.48). Vardenafil demonstrated significant efficacy in the treatment of ED, but the optimal dose and course of vardenafil remain to be established.

Surgically induced weight loss effects on sexual quality of life of obese men: a prospective evaluation.

Sexual difficulties are common among obese patients, but only a few research studies have examined the relationship between obesity and sexual quality of life (QoL). The aim of this study is to investigate the efficacy of bariatric surgery to improve sexual function and related quality of life in obese men. Prospective study including consecutive male patients undergoing bariatric surgery procedures, both sleeve gastrectomy and Roux en Y gastric bypass, between 2013 and 2017. Anthropometric parameters, biochemical and hormonal assessment and QoL questionnaires [International Index of Erectile Function (IIEF), Sexual Desire Inventory (SDI), Short Form-36 (SF-36) health survey questionnaire] were collected before and 12months after surgery. 44 male patients were recruited in the study. 40/44 (90.91%) underwent a SG and 4/44 a RYGB (9.09%). Median age was 43.45years. Waist Circumference, Hip Circumference, body weight and body mass index significantly decreased 12months after surgery, with a median weight loss of 49kg and a median BMI difference of 14.28kg/m2 12months after surgery. Basal glycaemia, HbA1c, basal insulin, triglycerides, HDL cholesterol and CRP levels significantly decreased, while FSH, total testosterone and SHBG levels significantly increased. IEEF total score was significantly higher 12months after surgery. Univariate analysis identified SHBG, estradiol and inhibin B levels, IIEF erectile function, IIEF intercourse satisfaction, IIEF total and SF-36 physical functioning scores as significant negative predictive factors of sexual improvement. None of them reached the statistical significance in the multivariate analysis. Sexual impairment in morbidly obese men represents an underestimated problem, with a high prevalence in the IIEF domains in our series. Bariatric surgery represents the most effective therapy of morbid obesity, having a tremendous impact on metabolic profile, sexual function and self-perceived QoL.

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.

Effect of Reduction Mammaplasty on Sexual Activity.

This study aimed to evaluate the effects of reduction mammaplasty operation on sexual functions of the patients with macromastia and of their partners. Thirty-nine patients with macromastia and their partners were assessed for their sexual function before and 6 months after reduction mammaplasty. Sexual function of the women and their partners were evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF), respectively. Controls (n = 33) were chosen from healthy hospital staff and their partners. Preoperative and postoperative scores were statistically compared with the controls' scores by using Student t test. Also, preoperative and postoperative scores were compared by using paired t test. The mean of age and body mass index of the women and their partners in the patient and control group were similar (P = 0.07). Before the operation, the mean of IFSF scores in the patient and control group were 22.75 (3.45) and 27.28 (5.05), respectively (P < 0.001). After the operation, the mean of IFSF scores in the patient group increased significantly to 27.67 (P < 0.001). The postoperative scores of all IFSF subscales except lubrication subscale were higher than the preoperative scores. Although there was no significant difference between preoperative and postoperative IIEF-total scores, postoperative IIEF-erectile function and IIEF-intercourse satisfaction scores were significantly reduced (P < 0.05). We found that macromastia adversely affected female sexual function but reduction mammaplasty eliminated this adverse effect. We also found that the partners' erectile function and intercourse satisfaction reduced after the operation. This reduction may be due to psychological effects.

A prospective study on association of prostatic calcifications with sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common debilitating condition of unclear etiology. Sexual dysfunction is an important component of the clinical phenotype of CP/CPPS. Patients often have prostatic calcifications, but a link to sexual dysfunction is unknown. The aim of this study was to evaluate the association of prostatic calcifications with sexual dysfunction in this condition. A total of 358 males with CP/CPPS were consecutively enrolled, and a prospectively maintained database of these patients was analyzed. Calcifications were diagnosed using ultrasound imaging of the prostate. Symptom severity was measured using the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). Sexual dysfunction was evaluated using the validated 15-item International Index of Erectile Function (IIEF-15) questionnaire and 5-item Premature Ejaculation Diagnostic Tool scales. The variables were compared between patients with prostatic calcifications and those without using the Student's t-test, Wilcoxon unpaired test, or chi-square test. Logistic regression models were developed to explore a possible association between prostatic calcifications and sexual dysfunction. Measurable calcifications in the prostate were found in 175 (48.9%) of the 358 patients. Patients with calcifications were more likely to have higher white blood cell counts or positive bacteria cultures in their prostatic fluid, longer symptoms duration, and lower scores for the total IIEF-15, IIEF-erectile function, and IIEF-intercourse satisfaction domains (P < 0.001 for each). However, the scores for CPSI, premature ejaculation, and IIEF-orgasmic function, IIEF-sexual desire, and IIEF-overall satisfaction domains were identical between men with and without calcifications (P > 0.05 for each). Furthermore, logistic regression analyses revealed that intraprostatic calcification is significantly associated with self-assessed erectile dysfunction (ED) (odds ratio:3.632, 95% confidence interval: 2.405-5.822, P < 0.001). Our results showed that prostatic calcifications are significantly associated with the presence of ED in CP/CPPS males.

Insulin Resistance Is an Independent Predictor of Severe Lower Urinary Tract Symptoms and of Erectile Dysfunction: Results from a Cross-Sectional Study

Several studies have linked the association between lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and the presence of insulin resistance (IR) due to an underlined metabolic syndrome (MetS). This study aims to determine the relationship between IR, sexual function, and LUTS and to demonstrate the ability of IR in predicting ED and severe LUTS. Between January 2008 to January 2013, 544 consecutive patients with benign prostatic hyperplasia-related LUTS were enrolled. LUTS and sexual function of the patients were evaluated by the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS). MetS was defined by the International Diabetes Federation. IR was defined as a homeostasis model assessment (HOMA) index of 3 or greater. Uni- and multivariate logistic regression analysis was performed to assess significant predictors of severe LUTS (IPSS ≥ 20) and ED (IIEF-Erectile Function [IIEF-EF] <26), including MetS component, prostate volume, prostate-specific antigen, total testosterone, and HOMA index. IR patients resulted in higher values of IPSS (19.0 vs. 15.0; P<0.01), IPSS-storage (6.0 vs. 5.0; P<0.01), IPSS-voiding (12.0 vs. 9.0; P<0.01), total prostate volume (54.8 vs. 36.5; P<0.01), and lower values of IIEF-EF (17.0 vs. 20.0; P<0.01), IIEF-Intercourse Satisfaction (3.0 vs. 10.0; P<0.01), IIEF-Orgasmic Function (8.0 vs. 9.0; P<0.01), IIEF-Overall Satisfaction (6.0 vs. 8.0; P<0.01), and total testosterone (3.83 vs. 4.44; P<0.01). IR was demonstrated to be a strong predictor of ED (IIEF-EF <26) (odds ratio [OR] =6.20, P<0.01) after adjusting for confounding factors. Finally, IR was also an independent predictor of severe LUTS (IPSS ≥ 20) (OR=2.0, P<0.01) after adjusting for confounding factors. IR patients are at high risk of having severe LUTS and contemporary sexual dysfunctions. We strongly suggest to prevent LUTS and ED by reducing insulin resistance.

Tadalafil Once Daily Improves Ejaculatory Function, Erectile Function, and Sexual Satisfaction in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia and Erectile Dysfunction: Results from a Randomized, Placebo- and Tamsulosin-Controlled, 12-Week Double-Blind Study

Tadalafil, a long-acting phosphodiesterase type 5 inhibitor, is approved for treating signs and symptoms of benign prostatic hyperplasia (BPH) and erectile dysfunction (ED); tamsulosin, an alpha-blocker, is approved for treating signs and symptoms of BPH. To determine the effects of tadalafil or tamsulosin on sexual function, including ejaculation and orgasm, satisfaction, and erectile function, in sexually active men with ED and lower urinary tract symptoms suggestive of BPH (LUTS/BPH). A randomized, double-blind, placebo-controlled study of tadalafil 5 mg once daily for 12 weeks in men with LUTS/BPH; tamsulosin 0.4 mg once daily was an active control. The International Index of Erectile Function (IIEF) questionnaire was administered at baseline and 4, 8, and 12 weeks. Analysis of orgasm and ejaculation was post hoc based on the IIEF-Orgasmic Function (OF) domain (IIEF-Q9 [ejaculatory frequency] and Q10 [orgasmic frequency]). Other measures included IIEF-Intercourse Satisfaction (IS), Overall Satisfaction (OS), and Erectile Function (EF) domains. Changes from baseline to 12 weeks (or last observation) vs. placebo were analyzed using analysis of covariance. Higher IIEF scores indicate better functioning. Of 511 study participants, 310 (60.7%) had ED and were sexually active. The IIEF-OF increased significantly through 12 weeks with tadalafil vs. placebo (P = 0.048), as did IIEF-Q9 (P = 0.045) but not IIEF-Q10 (P = 0.100). Compared with placebo, IIEF-OF, Q9, and Q10 decreased significantly with tamsulosin (all P < 0.05). The IIEF-IS and OS increased significantly at end point with tadalafil (both P < 0.001); for tamsulosin, change was not significant for IS, while OS decreased significantly (P = 0.009). The IIEF-EF domain increased significantly vs. placebo with tadalafil (P < 0.001) but not tamsulosin (P = 0.699). Tadalafil 5 mg once daily significantly improved ejaculation and orgasm, intercourse and overall satisfaction, and erectile function. Men receiving tamsulosin 0.4 mg once daily experienced a decrease in both ejaculatory/orgasmic frequency and overall satisfaction vs. placebo, with no significant effect on erectile function.

Factors associated with preference for sildenafil citrate and tadalafil for treating erectile dysfunction in men naïve to phosphodiesterase 5 inhibitor therapy: post hoc analysis of data from a multicentre, randomized, open‐label, crossover study

To determine if baseline characteristics, treatment efficacy, psychosocial outcomes or tolerability were associated with patient preference for sildenafil citrate (sildenafil) or tadalafil for treating erectile dysfunction (ED) in men naive to phosphodiesterase 5 inhibitor therapy. In an open-label, crossover study of sildenafil (25, 50 or 100 mg) and tadalafil (10 or 20 mg), dosed as needed, after a 4-week baseline assessment, 367 men with ED were randomly assigned to sildenafil followed by tadalafil or vice versa (8-week dose optimization and 4-week assessment phase for each treatment period). Patients completing both periods chose which treatment they preferred for an 8-week extension phase. Bivariate logistic regression and stepwise logistic regression were used to determine if any baseline characteristics or post-baseline measurements were associated with the patients' treatment preference. Baseline variables examined were age, race, ED aetiology/duration, body mass index, smoking status, alcohol consumption, vital signs, comorbid medical conditions, and baseline scores for the International Index of Erectile Function (IIEF) domains, Psychological and Interpersonal Relationship Scales (PAIRS) domains, and Sexual Encounter Profile (SEP) diary questions. Post-baseline variables examined were therapy sequence, dosage, and differences in IIEF and PAIRS domains, SEP scores, in number/timing of sexual attempts and in the severity of side-effects (overall patient perception). Of 291 patients completing both treatments and indicating a preference, 85 (29%) preferred sildenafil and 206 (71%) preferred tadalafil. Variables were individually analysed using bivariate analysis; one baseline characteristic (presence/absence of hyperlipidaemia) and 13 post-baseline measurements were significantly associated with the patients' treatment preference. Variables were analysed as a group using stepwise logistic regression; a set of six post-baseline factors was identified as significantly associated with patient preference. Dosage choice, reductions in the PAIRS time concerns domain, IIEF intercourse satisfaction domain improvements, smaller side-effect severity scores, more sexual attempts, and increased SEP4 scores (satisfaction with erection hardness) during the tadalafil or sildenafil treatment periods were all significantly associated with preference for tadalafil or sildenafil. We identified no baseline characteristics that prospectively distinguish patients who will prefer tadalafil or sildenafil. Patient differences in time concerns, dosage choice, intercourse satisfaction, treatment tolerability, number of sexual attempts and satisfaction with erection hardness were the set of factors most significantly associated with treatment preference, and the preference observed for tadalafil (71%) or sildenafil (29%) might be substantially accounted for by differences in these factors during the tadalafil and sildenafil treatment periods.

Spotlight on vardenafil in erectile dysfunction.

Vardenafil (Levitra) is a potent and highly selective oral phosphodiesterase type 5 (PDE5) inhibitor. Vardenafil improved erectile function in men with mild to severe erectile dysfunction (ED) of varying aetiology in two randomised, double-blind, multicentre, fixed-dose studies of 12 or 26 weeks' duration. Men receiving vardenafil 10 or 20mg had significantly greater improvements in International Index of Erectile Function (IIEF) questionnaire erectile function domain scores than placebo recipients. Moreover, improvements in penetration and maintenance of erection (assessed using IIEF or Sexual Encounter Profile [SEP] questions) were significantly greater with vardenafil 5-20mg than with placebo. Improvements in IIEF intercourse satisfaction and orgasmic function domain scores were significantly greater with vardenafil 10 or 20mg than with placebo and the proportion of patients with a positive response to a Global Assessment Question (GAQ) concerning improvement in erections after 12 or 26 weeks' therapy was significantly higher with vardenafil 5-20mg than with placebo. Vardenafil improved erectile function in men with ED associated with diabetes mellitus or ED following unilateral or bilateral nerve-sparing radical retropubic prostatectomy in two randomised, double-blind, multicentre, fixed-dose, 3-month studies. In both studies, improvements from baseline in the erectile function domain score of the IIEF and in positive responses to SEP questions were significantly greater with vardenafil 10 or 20mg than with placebo. In addition, a significantly higher proportion of vardenafil 10 or 20mg recipients than placebo recipients had positive GAQ responses. Vardenafil was generally well tolerated in men with ED; treatment-emergent adverse events were of mild to moderate intensity and transient in nature. The most commonly reported adverse events (typical of those seen with PDE5 inhibitors) in vardenafil 5-20mg recipients included headache, flushing, rhinitis, dyspepsia and sinusitis. There were no reports of abnormal colour vision in men with ED taking vardenafil at clinically recommended doses (5-20mg). Vardenafil is a potent and highly selective oral PDE5 inhibitor. It is effective and generally well tolerated in men with mild to severe ED of varying aetiology, as well as in men with ED associated with diabetes mellitus or ED after radical prostatectomy. Vardenafil should be considered a first-line treatment option in men with ED who are suitable candidates for oral PDE5 inhibitor therapy.

Vardenafil: a review of its use in erectile dysfunction.

Vardenafil (Levitra) is a potent and highly selective oral phosphodiesterase type 5 (PDE5) inhibitor. Vardenafil improved erectile function in men with mild to severe erectile dysfunction (ED) of varying aetiology in two randomised, double-blind, multicentre, fixed-dose studies of 12 or 26 weeks' duration. Men receiving vardenafil 10 or 20 mg had significantly greater improvements in International Index of Erectile Function (IIEF) questionnaire erectile function domain scores than placebo recipients. Moreover, improvements in penetration and maintenance of erection (assessed using IIEF or Sexual Encounter Profile [SEP] questions) were significantly greater with vardenafil 5-20 mg than with placebo. Improvements in IIEF intercourse satisfaction and orgasmic function domain scores were significantly greater with vardenafil 10 or 20 mg than with placebo and the proportion of patients with a positive response to a Global Assessment Question (GAQ) concerning improvement in erections after 12 or 26 weeks' therapy was significantly higher with vardenafil 5-20 mg than with placebo. Vardenafil improved erectile function in men with ED associated with diabetes mellitus or ED following unilateral or bilateral nerve-sparing radical retropubic prostatectomy in two randomised, double-blind, multicentre, fixed-dose, 3-month studies. In both studies, improvements from baseline in the erectile function domain score of the IIEF and in positive responses to SEP questions were significantly greater with vardenafil 10 or 20 mg than with placebo. In addition, a significantly higher proportion of vardenafil 10 or 20 mg recipients than placebo recipients had positive GAQ responses. Vardenafil was generally well tolerated in men with ED; treatment-emergent adverse events were of mild to moderate intensity and transient in nature. The most commonly reported adverse events (typical of those seen with PDE5 inhibitors) in vardenafil 5-20 mg recipients included headache, flushing, rhinitis, dyspepsia and sinusitis. There were no reports of abnormal colour vision in men with ED taking vardenafil at clinically recommended doses (5-20 mg). Vardenafil is a potent and highly selective oral PDE5 inhibitor. It is effective and generally well tolerated in men with mild to severe ED of varying aetiology, as well as in men with ED associated with diabetes mellitus or ED after radical prostatectomy. Vardenafil should be considered a first-line treatment option in men with ED who are suitable candidates for oral PDE5 inhibitor therapy.