International Index Of Erectile Function Questionnaire Research Articles

(209) Four-Year Real-world Sexual Function Outcomes of Rezum Therapy in Patients With and Without Erectile Dysfunction

Abstract Introduction Multiple studies have demonstrated Rezum therapy to effectively alleviate lower urinary tract symptoms secondary to benign prostatic hyperplasia while preserving sexual function. However, long-term real-world outcomes on sexual function are lacking in patients with baseline erectile dysfunction (ED) following Rezum treatment. Objective To compare four-year sexual function outcomes after Rezum between patients with and without baseline ED. Methods A retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017-2019. Patients were stratified into one of two cohorts based on presence or absence of ED at baseline. Sexual function was assessed with the validated 15-question International Index of Erectile Function (IIEF) questionnaire. Those who completed the IIEF questionnaire at baseline and 6-, 12-, and/or 48-months postoperatively were included. Function domains were calculated based on IIEF guidelines on clinical application of the questionnaire, and included erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Results Ninety-one patients were included: 44% (40) with baseline ED and 56% (51) without baseline ED. At baseline, 50% of the ED cohort were taking ED medications. No significant differences were found in age, prostate volume, and past medical history of hypertension or dyslipidemia between the cohorts. The ED cohort had a significantly greater proportion of patients with diabetes mellitus when compared to non-ED cohort (35 vs 15.7%, p=0.048). At baseline, the ED cohort had significantly lower scores for the IIEF domains of erectile function (p=0.007), orgasmic function (p=0.034), intercourse satisfaction (p=0.033), and overall satisfaction (p=0.002) when compared to the no ED cohort. Between the cohorts, no significant differences in the number of injections utilized during treatment in the lateral or medial prostatic lobes were observed. Compared to baseline, there was no significance in any IIEF domains in either cohort at 6-months. At 12-months, the ED cohort had significant percent decreases in orgasmic function (-25%, p=0.018), sexual desire (-22.2%, p=0.039), and overall satisfaction (-33.3%, p=0.004), while the non-ED cohort had a significant percent increase in erectile function (5%, p=0.04) when compared to baseline. At 48-months, the non-ED cohort had no significant changes in any IIEF domains, while the ED cohort had significant percent increases in erectile function (30%, p=0.013), sexual desire (22.5%, p=0.023), intercourse satisfaction (20%, p=0.011), and overall satisfaction (58.3%, p=0.008). At 48-months, there were no cases of de novo ED in the non-ED cohort and no significant changes in ED medications in the ED cohort when compared to baseline (53.3 vs 46.7%, p=0.72). Conclusions At long-term, Rezum preserved sexual function in patients with no baseline ED and improved sexual function in patients with baseline ED. However, patients with baseline ED may experience temporary decreases in sexual function at 12-months postoperatively. Additional larger studies are warranted to further evaluate these real-world results. Disclosure No.

Psychosexual dysfunction in male patients with cannabis dependence and synthetic cannabinoid dependence.

There are contradicting reports regarding the relationship between cannabis use and male sexual functions with almost no data about synthetic cannabinoids (SC) and its effect on male sexual functions. This study investigates psychological concerns related to male sexual functions among cannabis and SC users. The research aims to assess different sexual functions and aspects of sexual psychopathology in cannabis and SCs dependent men compared to controls. Thirty male patients with cannabis dependence, thirty male patients with SCs dependence and thirty matched controls from the outpatient clinic of Kasr Al Ainy hospital, Egypt, were assessed using Structured Clinical Interview for DSM-IV TR Axis I Disorders (SCID-I), International Index of Erectile Function (IIEF), and Sexuality scale. The means of IIEF questionnaire in the cannabis and SC group were significant lower than the means of the control group (P < .001) except the orgasmic function in cannabis group (P = .052). In the SCs group, sexual depression was higher and preoccupation lower than the cannabis (P < .020; P < .003, respectively) and control groups (P < .001; P < .001, respectively). The duration and dose of intake of cannabis and SCs correlated significant with sexual esteem, sexual preoccupation and all domains of IIEF. Cannabis and SC dependence were associated with lower erectile function, sexual desire, intercourse satisfaction and overall satisfaction, and lower orgasmic functions in the SC group than controls. Both groups showed higher sexual depression, lower sexual esteem and sexual preoccupation than controls. SC has a higher negative impact on male sexual functions and psychopathology than cannabis.

Does Significant Weight Loss After Bariatric Surgery Affect Sexual Function and Urinary Symptoms? An Iranian Study.

For sexual dysfunction and lower urinary tract symptoms (LUTS), obesity is identified as an independent risk factor. The current study aimed to evaluate the effect of significant rapid weight loss by bariatric surgery on LUTS and sexual function among men and women with class III obesity. A group of patients who were planned to undergo bariatric surgery was enrolled in the study. Male patients were given the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaires. In the female group, they filled in the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) questionnaires. Patients were followed up 1year after their bariatric surgery. All questionnaires were completed by eighty-one patients. (mean age ± SD: 39.4 ± 9.2years; mean body mass index (BMI) ± SD: 47.15 ± 5.4kg/m2). The total score of the IPSS questionnaire decreased from 5.83 ± 3.01 preoperatively to 2.37 ± 1.66 postoperatively. The weight loss caused significant improvement in the storage phase of LUTS domains, but there were no considerable changes in the voiding phase. In the IIEF questionnaire, domains of sexual desire, overall satisfaction, and orgasmic function improved significantly. There was not a significant change in any FSFI domains after bariatric surgery. Mean ICIQ-SF decreased, but it was not substantial. Bariatric surgery can significantly improve the storage phase in men, but not the voiding phase. Sexual desire, orgasmic function, and overall satisfaction were significantly improved in men. No significant improvement in sexual function and UI in women was observed.

Carotid artery intima media thickness can predict the response to phosphodiesterase 5 inhibitors in patients with moderate erectile dysfunction.

Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature. We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I). A total of 274 subjects were divided into two groups: ED patients (n = 150) and controls (n = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild-moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders. Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED. Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group (P =.021, P = .006, and P < .001, respectively). The IIEF-5 score was significantly lower in the ED group (P < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders (P = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders (P = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682-0.921) (P = .001), and the cutoff value was determined to be 0.825mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity. Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon. There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist. CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild-moderate ED.

Influence of Bariatric Surgery on Erectile Dysfunction—a Systematic Review and Meta-Analysis

IntroductionObesity is associated with a higher prevalence of various comorbidities including erectile dysfunction (ED). Bariatric surgery leads to weight loss and remission of weight-related diseases. The exact influence of bariatric treatment on ED is yet to be established; however, the number of papers on the subject is growing.MethodologyA systematic review with meta-analysis comparing erectile dysfunction before and after surgery was conducted according to PRISMA guidelines with a literature search performed in June 2022. Inclusion criteria involved (1) ED assessment using the International International Index of Erectile Function (IIEF) and (2) longitudinal study design. Secondary endpoints involved hormonal changes and specific fields of IIEF.ResultsAn initial search yielded 878 records. Fourteen studies were included in the meta-analysis involving 508 patients. The quality of analyzed studies was moderate. Analysis showed significant differences in IIEF before and after surgery (Std. MD = 1.19, 95% CI 0.72 to 1.66, p<0.0001). Testosterone after surgery is higher by 156.32 pg/ml (95% CI 84.78 to 227.86, p<0.0001). There were differences in erectile function (MD:4.86, p < 0.0001), desire (MD: 1.21, p < 0.0001), intercourse satisfaction (MD: 2.16, p < 0.0001), and overall satisfaction (MD: 1.21, p = 0.003). There were no differences in terms of orgasms (MD: 0.65, p = 0.06).ConclusionThere are differences in ED before and after bariatric surgery. Patients achieve 19% more in the IIEF questionnaire showing improvement. Further studies, including multivariate regression models on large cohorts, are required to determine whether the surgery is an independent factor in alleviating ED.Graphical

Effects of bariatric surgery on testosterone level and sexual function in men with obesity: A retrospective study.

Bariatric surgeries induce well-documented weight loss and resolve obesity comorbidities. Sexual function is one of the aspects of life quality and may benefit from surgery. Few studies have revealed the impact of bariatric surgeries on sexual function in Chinese men with obesity. This is a retrospective cohort study of patients undergoing bariatric surgery [laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB)]. Data were collected between September 2017 and February 2022. The International Index of Erectile Function (IIEF) questionnaire was used to evaluate erectile function, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Sex hormones and other blood tests were evaluated before and at least 1 year after the surgery. Fifty-nine Chinese male patients completed the IIEF questionnaire. The multivariate logistic regression analysis revealed that body mass index (BMI) was the single independent risk factor of the severity of erectile dysfunction (ED). Preoperative testosterone levels had negative correlations with BMI and waist circumference. Thirty-seven patients completed the postoperative questionnaire with a mean follow-up of 23.2 months. BMI and waist circumference were negatively correlated with testosterone levels. BMI was an independent risk factor for the severity of ED. LSG and LRYGB led to positive and sustained improvement in sexual function of men with obesity. The two procedures had a comparable effect, more subjects being needed. Sex hormone levels also could be reversible. However, more weight loss did not predict a positive change in sexual function. A greater BMI loss might predict a greater increase in testosterone.

COVID-19 vaccination does not affect male sexual functions

BackgroundCOVID-19 infection has been linked with erectile dysfunction, which has also raised apprehensions about the impact of COVID-19 vaccination on male sexual functions. The purpose of this study was to investigate the impact of COVID-19 vaccination on male sexual functions, such as erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction.MethodsWe used International Index of Erectile Function (IIEF) questionnaire for data collection. Mixed methods were adopted for this study, which consisted of Google online form distribution and the distribution of hard copies of the form to those who were not internet friendly. All data were entered in a spreadsheet and scores were assigned to each response according to the standard scores given in the IIEF questionnaire. Fifteen questions, one corresponding to each question in the IIEF questionnaire, were included to assess the impact of COVID-19 vaccination on each sexual function.ResultsIn the first part of analysis, we calculated sexual function scores and men reporting low sexual function scores (~ 15%) were excluded, providing us with 465 individuals for further analysis. Regarding the impact of COVID-19 vaccination on male sexual functions, 71% individuals reported no impact, 3% reported a decline, 2.7% reported an improvement, and 23.3% could not assess the impact. We also performed analysis on the basis of age-groups of the participants and the duration after vaccination, finding that there was no impact irrespective of the age of subjects or the length of period after vaccination.ConclusionsCOVID-19 vaccination does not affect male sexual functions, including erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall sexual satisfaction.

Selecting an Individualized Treatment Approach: The Predictive Value of Erotic Stimulation and Nocturnal Erections for Efficacy of Tadalafil and Cure in Patients With Erectile Dysfunction.

PurposeThis study aimed to evaluate two modes of Rigiscan for predicting tadalafil response, and to identify which Rigiscan variables are the most efficient at making these predictions.MethodsAll patients received at least two rounds of nocturnal penile tumescence and rigidity (NPTR) testing and/or audiovisual sexual stimulation (AVSS), then completed the International Index of Erectile Function-5 (IIEF-5) questionnaire, followed by oral 5 mg tadalafil daily for 4 weeks. After a 4-week washout period, all respondents underwent an the IIEF-5 questionnaire again. ED patients were then categorized into tadalafil responders and tadalafil non-responders, who were then further divided into cured patients and uncured patients.ResultsWhen predicting tadalafil responders, the area under the curve (AUC) of NPTR was superior to that of AVSS (0.68~0.84 VS 0.69~0.73), and the predicted optimal cut-off values were DOEE60≥17.75 min in NPTR, compared to other parameters regardless of AVSS or NPTR (P<0.05). When predicting which patients would be cured, the AUC of AVSS was superior to NPTR parameters (0.77~0.81 vs 0.61~0.76), and the determined best diagnostic cut-off values were DOEE≥4.125min in AVSS, compared to other parameters regardless of AVSS or NPTR (P < 0.05).ConclusionRigiscan was able to predict the efficacy of daily tadalafil accurately and efficiently. Its diagnostic value was at maximum when DOEE60 ≥17.75 min of NPTR in tadalafil responders and DOEE ≥ 4.125 min of AVSS in cured patients.

The Value of the International Index of Erectile Function (IIEF) in Characterizing the Erectile Function in Patients with Peyronie's Disease

ABSTRACT Introduction Peyronie's Disease (PD) is characterized by physical deformity in the penis that often has a negative impact on the sexual relationship of the patient and his partner. The International Index of Erectile Function (IIEF) is a standardized patient questionnaire used to measure various aspects of erectile performance and the severity of erectile dysfunction. IIEF accuracy in patients with Peyronie's disease has been criticized as the questions that compromise this tool inquire about sexual activity and intercourse in the patient over the past 30 days, not considering the fact that those patients are able to achieve adequate erection for intercourse but do not engage either due to physical difficulty due to curvature or psychological stress, hence misrepresenting the degree of erectile dysfunction. Objective In this study, we correlate the IIEF score domain with the presence of vascular abnormalities on penile duplex doppler ultrasound (PDDU) during the evaluation of patients for PD. Methods We evaluate all patients presenting with symptoms suggestive of PD with a PDDU for better counseling on different treatment options. The IIEF questionnaire is filled at the beginning of each study. Arterial insufficiency is characterized by peak systolic velocity (PSV) less than 30 ml/sec, while venous leak is characterized by end-diastolic velocity (EDV) more than 5 ml/sec. Those measurements are obtained at 10, 15 and 20 min after injecting intracevrnosal vasoactive agent, while recording the tumescence and rigidity at each time point. In addition, we correlate the severity of IIEF score with the prevalence of vascular abnormalities detected in the PDDU study. Results 540 consecutive patients between January 2016 and December 2020 were included in this study. The mean age of the cohort was 55.1 years. The average curvature was 53.3 degrees, with mean tumescence and rigidity achieved 90% and 70.6%, respectively. Graph 1 shows the distribution of the different vascular abnormalities detected on the PDDU in each category of IIEF abnormality. There is a clear decreasing trend of finding non-vascular abnormalities as the IIEF value decrease from None to Severe (Figure 1). Additionally, there is concomitant rise in the amount of arterial insufficiency and venous leak (counting venous leak and mixed etiology) as the severity measured on IIED questionnaire increases. Conclusions While IIEF questionnaire has been criticized in patients with PD as being an inaccurate assessment of erectile function, it seems to still be of a value and roughly correlates with PDDU findings. After analyzing data from our cohort, IIEF has the potential assist in treatment decision making as a screening tool for need of additional tests with higher specificity. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharma

Spanish Cross-Cultural Validation of the Electronic Version of the International Index of Erectile Function-5 (IIEF-5).

The IIEF-5 questionnaire is a validated scale used as a diagnostic tool in erectile dysfunction (ED). This simplified version includes five items that focus on erectile function and satisfaction during sexual intercourse; it has favourable properties for detecting the presence and severity of erectile dysfunction The main objective of this study was to make a cross-cultural adaptation to Spanish of the IIEF-5 scale and to evaluate its psychometric properties of validity, reliability, and feasibility in the Spanish population. Validation of the IIEF-5 included: (i) professional translation of the scale; (ii) scientific evaluation of the translation; (iii) professional retranslation; (iv) assessment of 10 individuals to test correct comprehension and idiomatic adequacy; (v) validation of the IIEF-5 by an online survey. The study sample consisted of 100 participants, who received the online form either directly or through other participants who distributed it. Participants obtained a mean score of 22.3 (SD 2.7), implying normal erectile function. However, 23 results of mild dysfunction (n = 23) and 2 of mild to moderate dysfunction (5.1%) were identified. A Cronbach’s alpha coefficient of 0.75 was obtained for the total of the final questionnaire, indicating high reliability. Validity analysis had a value of 0.784 (>0.5) and was therefore considered appropriate. The IIEF-5 scale is a reliable tool to test ED, and its Spanish version is satisfactorily understood by patients.

Association Between Chronic Periodontal Disease and Erectile Dysfunction: A Case-Control Study.

Erectile dysfunction (ED) and chronic periodontal disease (CPD) share mutual risk factors, and the incidence of ED is increasing among young adults. The relation of CPD and ED remains obscure due to inconsistent clinical evidence. This study aimed to further assess the relationship between CPD and ED using the Community Periodontal Index of Treatment Need (CPITN) and the International Index of Erectile Function (IIEF). Totally, 202 adult men were included, with 100 subjects with ED in the case group and 102 subjects without ED undergoing routine dental examinations in the control group. The IIEF questionnaire was used to assess the severity of ED, and CPD was assessed through the Community Periodontal Index (CPI) score. Periodontal assessments were performed by one single calibrated examiner. Logistic regression analysis was performed for the association between CPD and ED. After adjustment for age, smoking status, tooth brushing time, education level, monthly income, tooth brushing frequency, and gum bleeding, higher CPI score was identified to be associated with a greater risk of ED (odds ratio [OR] = 2.755, 95% confidence interval [CI] = [1.400, 5.423], p = .003), suggesting that CPD was positively associated with the odds of ED. CPD was getting more severe with the progress of ED (p < .05). Men with ED could be encouraged to receive routine dental examinations and appropriate preventive dental measures to maintain oral and periodontal health.

Effect of Topical Clove (Syzygium aromaticum (L.) Merr. &amp; L.M.Perry) Gel on Premature Ejaculation: A Pilot Randomized Double-Blind Placebo-Controlled Clinical Trial

Premature ejaculation is one of the most common sexual disorders worldwide without a satisfying treatment. In this study, we investigated the efficacy of a topical formulation of clove oil in premature ejaculation patients. Eligible patients were randomly divided into two groups to use either Syzygium aromaticum (SA) 1% gel or placebo gel 10 minutes before the intercourse for a period of 8 weeks. Outcome measurement were Premature Ejaculation Diagnostic Tool (PEDT) and International Index of Erectile Function (IIEF) questionnaires in addition to Intravaginal Ejaculation Latency Time (IELT). A total number of 22 (11 patients in each group) participants completed the study. At the end of the intervention, the IELT scores changed from 29.84 ± 18.59 to 97.09 ± 91.86 and 42.51 ± 13.98 to 52.45 ± 32.7 seconds in SA gel and placebo groups, respectively (p-value = 0.003). Also, the changes of PEDT scores in the SA gel group (from 14 ± 3.55 to 9.2 ± 4.56) comparing to that of placebo gel group (from 14.63 ± 3.61 to 13.5 ± 3.78) was significantly different (p-value =0.001). Moreover, results of IIEF questionnaire revealed significant improvement of “Intercourse Satisfaction” in SA gel group (p-value = 0.016). No adverse event was observed. It seems that SA gel could be beneficial in the treatment of premature ejaculation; however, it should be further evaluated in larger studies.

Mirabegron improves erectile function in men with overactive bladder and erectile dysfunction: a 12-week pilot study.

Phosphodiesterase type 5 inhibitors (PDE5i) is the only approved oral treatment for erectile dysfunction (ED) in the US, and alternative management remains necessary when this treatment fails or is contraindicated. Targeting other pathways than the NO-cGMP pathway and/or combining this approach with PDE5i may introduce new treatments for men who are unresponsive to PDE5i. This study aims to evaluate whether Mirabegron improves erectile function in men with concurrent overactive bladder and mild to moderate ED. Twenty subjects, 40-70 years old, registering International Index of Erectile Function (IIEF) score 11-25 and International Prostate Symptom Score 8-20, were treated with Mirabegron therapy for 12 weeks. Study participants were re-administered IIEF and OAB-q questionnaires on weeks 2, 4, 8, and 12 and assessed for adverse events. The primary and secondary endpoints were an increase in the IIEF-5 score of 4 units and a decrease in the Overactive Bladder questionnaire (OAB-q) symptom severity score of 10 units between study time points. Thirteen men completed the 12-week study. Mirabegron treatment improved the IIEF-5 scores in five patients (38.4%) by 4 points or more, whereas IIEF-5 scores were not affected by Mirabegron treatment in eight patients (61.5%). There were no clinically relevant decreases in the IIEF-5 score. Significant improvements were observed in intercourse satisfaction at week eight compared to baseline (p = 0.01). Orgasmic function and sexual desire were not affected by Mirabegron treatment. As expected, Mirabegron treatment reduced OAB symptoms based on OAB-q short form (p = 0.006) and OAB-q total health-related quality of life (HRQL) scores compared to baseline (p = 0.03). Residual bladder volumes were not affected by treatment. No serious side effects were reported during the study period. This study suggests that Mirabegron may improve both EF and OAB-related symptoms in some individuals without causing serious adverse events.

Erectile function in men with type 2 diabetes treated with dulaglutide: an exploratory analysis of the REWIND placebo-controlled randomised trial

Diabetes is a major risk factor for erectile dysfunction, however, the effect of GLP-1 receptor agonists on erectile dysfunction is unknown. We aimed to assess the incidence, prevalence, and progression of erectile dysfunction in men treated with dulaglutide compared with placebo, and to determine whether dulaglutide's effect on erectile dysfunction was consistent with its effect on other diabetes-related outcomes. The Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial was a double-blind, placebo-controlled randomised trial of the effect of dulaglutide on cardiovascular outcomes. REWIND was done at 371 sites in 24 countries. Men and women aged older than 50 years with type 2 diabetes, who had either a previous cardiovascular event or cardiovascular risk factors, were randomly assigned (1:1) to receive either dulaglutide or placebo. Participating men were offered the opportunity to complete the standardised International Index of Erectile Function (IIEF) questionnaire at baseline, 2 years, 5 years, and study end. We did an exploratory analysis, in which we included participants who completed a baseline and at least 1 follow-up IIEF questionnaire. The primary outcome for these analyses was the first occurrence of moderate or severe erectile dysfunction following randomisation, assessed by the erectile function subscores on IIEF. This analysis was part of the REWIND trial, which is registered with ClinicalTrials.gov, NCT01394952. Between Aug 18, 2011, and Aug 14, 2013, 3725 (70·1%) of 5312 male participants with a mean age of 65·5 years (SD 6·4 years) were analysed, of whom 1487 (39·9%) had a history of cardiovascular disease, and 2104 (56·5%) had moderate or severe erectile dysfunction at baseline. The incidence of erectile dysfunction following randomisation was 21·3 per 100 person-years in the dulaglutide group and 22·0 per 100 person-years in the placebo group (HR 0·92, 95% CI 0·85-0·99, p=0·021). Men in the dulaglutide group also had a lesser fall in erectile function subscore compared with the placebo group, with a least square mean difference of 0·61 (95% CI 0·18-1·05, p=0·006). Long-term use of dulaglutide might reduce the incidence of moderate or severe erectile dysfunction in men with type 2 diabetes. Eli Lilly and Company.

Safety and Efficacy Study of Collagenase Clostridium Histolyticum Applied With an Intensive Protocol in the Treatment of Peyronie's Disease.

IntroductionCollagenase clostridium histolyticum (CCH) is a treatment for Peyronie's disease (PD) whose efficacy and safety has been demonstrated using a classic protocol and a shortened protocol.AimTo evaluate the efficacy and safety of an even more intense protocol in which a CCH injection is applied for 3 separate cycles of 1 week.MethodsProspective, nonrandomized, clinical study of a cohort of 13 patients with PD and non-ventral curvatures, between 30 and 90 degrees and with stable disease were included. Under local anesthesia, 0.9 mg of CCH is infiltrated in 3 parallel and equidistant transverse bands across the plaque in 3 sessions separated by 1 week. Between sessions the patient is instructed to perform home modeling and penis stretching.Main Outcome MeasuresThe measurements collected were from girth, length of the penis and length of the plaque. Side and degree of curvature. Ultrasound evaluation of the plaque characteristics and assessing the interface between the tunica albuginea and Buck's fascia. Furthermore, questionnaires were collected: International Index of Erectile Function (IIEF) and 15-question and Peyronie's Disease Questionnaire (PDQ). All these parameters were evaluated before and after treatment.ResultsAn improvement in curvature was obtained in 76.9% of patients, reaching an improvement in the angle of curvature after the treatment cycles by an average of 19 ° (range 0-35 °) from the beginning. There are also improvements in the results of the IIEF and PDQ questionnaires. Length, penis girth, and plate length measurements hardly changed after treatment. Reported adverse effects are mild and limited to the penis.ConclusionsWe demonstrate the safety and efficacy of CCH in the treatment of PD using a more intense protocol than the previous ones. In addition, reducing the overall duration of allows for greater adherence and compliance of patients. Melgarejo-Segura MT, Funes-Padilla C, Morales-Martínez A, et al. Safety and Efficacy Study of Collagenase Clostridium Histolyticum Applied With an Intensive Protocol in the Treatment of Peyronie's Disease. Sex Med 2021;9:100375.

Prevalence of erectile dysfunction among Egyptian male patients with type 2 diabetes mellitus

Background and aimsThe relation between type 2 diabetes mellitus (T2DM) and erectile dysfunction (ED) has been identified in multiple studies. The aim of this cross-sectional study was to estimate the prevalence and to determine some associated factors of ED among a sample of adult Egyptian male patients with T2DM. MethodsThis cross-sectional study included 150 adult male patients with T2DM (aged 40–60 years) who attended the outpatient clinic of Diabetes in Alexandria Main University hospital. They were evaluated for the presence of ED which was assessed by the validated Arabic-translated five-item version of the International Index of Erectile Function-5 (IIEF-5) questionnaire. Fasting blood glucose (FBG), HbA1c, total serum cholesterol, HDL-C, total serum testosterone (TT) and urinary albumin creatinine ratio (uACR) were measured for all study subjects. ResultsThe prevalence of ED was 80% among the studied sample. Significant negative correlation was found between IIEF-5 score and age, duration of diabetes, FBG and urinary ACR; while there was a significant positive correlation between IIEF-5 score and serum total testosterone. On performing multiple linear regression analysis for the parameters affecting IIEF-5 questionnaire score, TT, urinary ACR, age and FBG were the independent predictors of ED. ConclusionED was a common finding in our sample of Egyptian men with T2DM. Poor glycemic control and albuminuria may be considered as independent risk factors for ED.

Detection of Coronary Artery Disease by an Erectile Dysfunction Questionnaire.

Background Erectile dysfunction (ED) has been become an important health challenge in recent years affecting the quality of life significantly. In addition to imposed social problems, it may warn the existence of cardiovascular diseases especially that of ischemic heart disease (IHD). We aimed to investigate the association between ED and coronary artery disease (CAD) in a population of patients with stable angina based on angiographic findings. Methods In this cross-sectional study, among patients who are diagnosed with stable angina referring for coronary angiography (excluding those with acute coronary syndrome), 200 patients were selected. They were divided equally into two groups of case and control. The former were positively CAD patients and the latter were normal peers, with respect to angiographic results. International index of erectile function (IIEF) questionnaire was used in order to evaluate erectile function during recent four weeks. Statistical analyses of the t-test and logistic regression were performed. The significance level was considered as a P value less than 5%. Results The age range of the patients was 40–65 years old. The case group was significantly older (P=0.001). There was a remarkable relation between the low score from IIEF (ED) and existence of CAD. Also, the severity of ED was in a close relationship with severity of CAD. In addition, dyslipidemia in terms of high LDL and low HDL was associated with both ED and severity of CAD. Conclusion Other than CAD, ED could be considered as one of the manifestations of atherosclerosis. Accordingly, the IIEF questionnaire is a useful tool to early diagnosis of CAD. Also, IIEF-derived scores estimate CAD severity. We suggest subjects with low score of IIEF examine their cardiovascular health with special attention to possible existence of IHD.

FACTORS INFLUENCING THE DEGREE OF ERECTILE DYSFUNCTION IN BICYCLE RACE ATHLETES

Objective: This research aims to identify factors influencing the degree of erectile dysfunction in bicycle racing athletes. Material &amp; Methods: This study used quantitative analysis and cross-sectional research design. Samples included in this research were 54 respondents in accordance to the inclusion and exclusion criteria of this study, and were willing to participate in this research. The data were collected using the IIEF-5 (International Index of Erectile Function-5) questionnaire. The data were then edited, coded and analyzed using Chi-square (bivariate analysis). Results: The results showed correlations between the degree of erectile dysfunction in bicycle race athletes and age (PR= 1.182; 95%CI= 0.403-3.465; p= 0.976), cycling history (PR= 0.462; 95% CI= 0.490-4363; p= 0.687), cycling frequency (PR=1.400; 95% CI= 0.299-6.560; p= 0.72), cycling duration (PR= 0.333; 95% CI= 0.074-1.507; p= 0.165), furthest cycling distance (PR= 0.883; 95% CI= 0.267-2.919; p= 1.00), and type of saddle (PR= 0.271; 95% CI= 0.481-1.547; p= 0.221) respectively. Conclusion: There were no significant correlation (p= &gt;0.05) in all variables analyzed in this study.

The relationship of psychogenic erectile dysfunction with coronavirus anxiety in the COVID-19 pandemic period

Background/aim: Our aim is to investigate the relationship of psychogenic erectile dysfunction(pED) that develops during the new coronavirus disease(COVID-19) pandemic with coronavirus anxiety using the Coronavirus Anxiety Scale(CAS) and the International Index of Erectile Function-5(IIEF-5) questionnaire. Materials and methods: This study was conducted in Elazig Fethi sekin city hospital during January 2021 to March 2021. Medical history of male patients who were admitted to urology outpatient clinics were taken and physical examinations were performed. Morning serum fasting glucose, total testosterone and prolactine levels were measured. IIEF-5 questionnaire was filled by the patients. Two groups were formed as pED and control group. Both groups filled the CAS questionnaire and the results were compared statistically. Results: IIEF-5 scores were 15.86±7.53 and 24.26±0.82 in the pED group and the control group, respectively. The CAS scores were 7.53±2.02 and 0.40±0.62 in the pED group and in the control group, respectively. There was a significant difference between these findings. There was a significant negative correlation between IEF-5 scores and CAS scores. (p*=0.00) IIEF-5 scores were significantly lower in the pED group compared to the control group. (p*=0.00) CAS scores were significantly higher in the pED group compared to the control group. (p*=0.00) While there was a statistically significant difference between moderate pED and mild moderate pED in terms of CAS scores (p*=0.02, p*=0.00), there was no statistically significant difference between mild moderate pED and mild pED. (p=0.27). Conclusion: In addition to high contagiousness and mortality rates, COVID-19 causes economic burden and financial losses, leading to negative individual and global psychosocial impact and increased anxiety. Since anxiety is one of the etiological causes of pED, pED encountered during the COVID-19 pandemic is also associated with coronavirus anxiety. Psychiatric support for coronavirus anxiety should be added to pED treatment. © 2021 A. CARBONE Editore. All rights reserved.

Early Effect of Metabolic Surgery on Erectile Function and Ejaculation: a Pilot Study of Obese Men with Type 2 Diabetes Mellitus.

Majority of men with type 2 diabetes mellitus (T2DM) have been reported to experience erectile dysfunction (ED) in a lifetime. The aim of our study was to prospectively evaluate the postoperative condition of ED and premature ejaculation (PE) in men who underwent metabolic surgery for the treatment of T2DM. A total of 36 sexually active male individuals with T2DM who were applied for metabolic surgery were given two different questionnaire forms prior to and 6months after the surgery. Patients filled the International Index of Erectile Function (IIEF) and the Premature Ejaculation Profile (PEP) questionnaires before and 6months after the surgery. The BMI, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) concentrations were also measured prior to the surgery and on follow-up points of postoperative first, third, and sixth months. Erectile function (EF) and overall satisfaction domains of the IIEF questionnaire increased significantly after the surgery in the patient groups irrespective of the previous ED severity (p< 0.001). There were significant improvements of the PEP interpersonal difficulty related to ejaculation score and HbA1c levels in the severe/moderate EF group and IIEF EF, PEP interpersonal difficulty related to ejaculation domains, and HbA1c levels of mild to moderate/mild/no ED group after the metabolic surgery. Metabolic surgery could improve erectile and ejaculatory function scores of obese patients with T2DM.