Management Of Male Sexual Dysfunction Research Articles

Cell therapy for male sexual dysfunctions: systematic review and position statements from the European Society for Sexual Medicine.

Cell therapy (CT) is a form of regenerative medicine under investigation for the management of male sexual dysfunction (MSD). We sought to perform a systematic review of published information on CT for MSD and provide an official position statements for the European Society for Sexual Medicine. A comprehensive bibliographic search on the MEDLINE, Web of Science, Scopus, and Cochrane Library databases was conducted in February 2023. Articles were selected based on the Population, Intervention, Comparator, Outcome, Study design (PICOS) model if they included male patients (P) undergoing CT (I) with or without comparison with other treatments (C) and evaluated the impact of CT on sexual function (O). Quantitative data were reported as found in the original studies (S). Level of evidence and grade of recommendation according to the Oxford Centre for Evidence-Based Medicine were assigned to each statement. Outcomes were determined based on assessment of erectile function, ejaculatory function, orgasmic function, sexual desire, and penile curvature. A total of 19 studies and 421 patients were included. Most articles (n = 12, 63%) were case series, whereas a minority of papers (n = 6, 32%) had a comparative group; only 2 articles reported randomized controlled trials (RCTs) and 1 article reported a post hoc analysis of RCTs. Most articles (16, 84%) investigated patients with erectile dysfunction (ED). Improvements in the International Index of Erectile Function-Erectile Function Domain (IIEF-EF) or the IIEF 5-item version (IIEF-5) were found in 11/15 (73%) studies, with mean increases in IIEF-EF, mean IIEF-5, and median IIEF-EF between 8 and 14 points, 2 and 9 points, and 4.5 and 6 points, respectively. Two papers (20%) evaluated men with Peyronie's disease (PD). In both ot these articles penile curvature improvement and plaque volume reduction were described in all patients (n = 16, 100%). Objective measurements were performed in 1 study, which showed 10°-120° (15%-100%) curvature improvement and 90%-100% plaque reduction. Mild transient adverse events at the donor or administration sites were found in 7/16 (44%) papers on ED. Priapism was reported in one case (20%) and mild penile skin complications were reported in the majority of patients after CT for PD. No severe adverse events were described. Although high-quality evidence is lacking, CT appears to have potential benefits from application in patients with ED or PD. This report is to our knowledge the most comprehensive and up-to-date systematic review on the topic of CT for the management of MSD, including the position statements of the European Society for Sexual Medicine. Overall the assessment of available studies demonstrated low quality and significant heterogeneity. Preliminary findings support potential efficacy and safety of CT in patients with ED or PD. Low-quality papers, high methodological heterogeneity, uncertainty about the magnitude of the beneficial effects, and lack of long-term data limit the available evidence.

(016) The Effect of Phosphodiesterase-5-inhibitor on Female Sexual Function: A Systematic Review and Meta-analysis

Abstract Introduction The link between the attainment of healthy sexual function and a high quality of life in women is well established. However, while the management of male sexual dysfunction has been afforded huge research and development, far less time and effort has been lent in the achievement of successful remedies for females experiencing sexual dysfunction. The use of oral phosphodiesterase type 5 (PDE5) inhibitors, such as Sildenafil, has been the mainstay of treatment for male sexual dysfunction for the last two decades. PDE5 inhibitors have been shown to initiate penile erection, through smooth muscle relaxation and the subsequent increase in intracellular cGMP levels. PDE5-containing cells, similar to those found in the penis, have also been confirmed within the clitoris. No previous pooled analysis has been performed, looking at the possible effect of PDE5 inhibitors on female sexual function, in a population comprising of heterosexual cisgender population. Objectives We aimed to perform a systematic review and meta-analysis of the best possible available studies, to evaluate the efficacy and safety of PDE5 inhibitors versus placebo when used in an exclusively female population. Methods We conducted a comprehensive search of electronic databases (MEDLINE, PubMed, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar, Web of Science, EBSCO Host, TRIP and Epistemonikos), identifying studies comparing the PDE5 inhibitors versus placebo, and the resultant effect on female sexual function. The Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modelling was used to calculate pooled outcome data. Results Searches of electronic databases resulted in 67 articles, from which 13 randomised control trials (RCTs) met the eligibility criteria, enrolling a total of 1605 patients. The use of PDE5 inhibitor was associated with a significantly improved orgasm satisfaction (P=0.01), increased sexual arousal (P=0.02), increase in sexual satisfaction (P=0.007) when compared to placebo. The use of PDE5i was also found to have a significant association with the incidence of headaches (P<0.0001) and flushing (P<0.00001). Conclusions Our meta-analysis demonstrated that the use PDE5 inhibitor was associated with a significantly higher attainment of orgasm satisfaction, sexual arousal, and sexual satisfaction when administered to a solely female population, when compared with placebo. However, the use of PDE5 inhibitors was also associated with a significantly increased risk of headache and flushing. Further large-scale high-quality RCTs are required in order to further evaluate the potential role of PDE5i’s in women, particularly in those suffering from significant sexual dysfunction. These future studies should focus on a more homogenous patient group, with stricter definitions of inclusion criteria. Disclosure

(223) Sexual Therapy: Patient-reported Barriers to Care

Abstract Introduction Sexual therapy for male sexual dysfunction has been used to help patients address a variety of sexual dysfunction-related conditions. While this intervention is frequently recommended for patients by male sexual health experts, the rate of adherence to the recommended therapy and associated factors is unknown. Objective To understand factors leading to completion of sex therapy consultations and barriers that prevent it. Methods A survey was developed by experts in the management of male sexual dysfunction and sex therapy at our institution. The survey included questions focusing on the decision to pursue sex therapy (or not), barriers or facilitating factors, patient perceptions regarding the referral, and treatment success. A retrospective chart review was performed to identify those patients who were referred for sexual therapy after undergoing evaluation for male sexual dysfunction at an academic Men’s Health urology clinic from 2017 - present. The survey was mailed out to these patients, and respondent survey data was compiled to evaluate survey responses. Results To date, 23 patients completed the survey (20% response rate). Sixty-five percent of survey respondents were ≥ 50 years of age, 87% were straight, and 71% were married. Reasons for sex therapy referral were frequently multi-factorial and included erectile dysfunction (65%, n=15), low libido (43%, n=10), ejaculatory dysfunction (39%, n=9), performance anxiety (30%, n=7), relationship problems (30%, n-7), and genital pain (14%, n=3). Seventy-eight percent of patients (n=18) felt that sex therapy consultation was a reasonable part of their treatment plans. Six (26%) patients did not attend their recommended sex therapy consultations. Reported barriers included sense of shame (n=2), embarrassment (n=2), scheduling conflicts (n=1), lack of anticipated benefits (n=1), and feeling dismissed by the referring provider (n=2). Those who attended sex therapy frequently reported the perception that referral made sense based on their symptoms (n=10, 59%) and/or a feeling of desperation to “do anything do get better” (n=11, 65%). Seventy-eight percent of patients who attended sex therapy found it helpful and would recommend it to a friend with a similar concern. Conclusions The majority of male patients who are referred to sexual therapy feel it is beneficial. However, one in four men choose not to pursue this line of treatment despite recommendations from their treating physicians. Future work is needed to address barriers to pursuing sex therapy. Disclosure No

The potential role of physical activity in the management of male sexual dysfunction

Physical activity is likely to be beneficial for male sexual health, with some evidence suggesting it could be as effective as pharmacological therapy for certain aspects of male sexual dysfunction. More evidence of efficacy of physical activity in sexual dysfunction is needed. However, insights into possible mechanisms linking physical activity with improved male sexual function may give doctors confidence in recommending it for their patients, while waiting for more robust clinical trial evidence.

Sexual Dysfunction After Spinal Cord Injury

Spinal cord injury (SCI) has a massive impact on sexual function in the affected population. Discussion of male and female sexual dysfunction in patients with SCI including the currently known management/treatment options is presented in this review. Sexual dysfunction is an important aspect of daily life that needs to be acknowledged, discussed and managed following spinal cord injury. There are pharmaceutical and technological advancements which allow patients to adjust to their new norm. Discussion about sexuality following injury should be normalized and encouraged since it is entirely possible to have a healthy sexual relationship following injury. Although there have been major strides in management of male sexual dysfunction following spinal cord injury, the same is not the case for their female counterparts. More research needs to be done on female sexual dysfunction, especially within the scope of patients with spinal cord injury since this is one of the major determinants owing towards quality of life for many individuals.

Management of male sexual dysfunction after cancer treatment

With an increase in the number of cancer survivors each year, male sexual dysfunction becomes an important topic for discussion between patients and providers who treat cancer. The aim of this article is to review types and mechanisms of sexual dysfunction after cancer therapy and discuss treatment options. Contemporary concepts regarding male sexual dysfunction after cancer treatment are reviewed and translated for clinical utility. To optimize recovery of erectile capacity after erectile dysfunction causing cancer treatments, a penile rehabilitation protocol involving phosphodiesterase inhibitors, vacuum erection device, intra corporal injections, or a combination is likely to provide some degree of clinically significant benefit. Treating hypogonadism post cancer treatment depends on the type of cancer that has been treated and patient comorbidities. Anejaculation after cancer treatments is typically not successfully or reliably treated due to the mechanism and severity of sympathetic nerve injury. Semen cryopreservation prior to cancer treatments that may injure nerve fibers essential for the ejaculatory response is highly recommended. Management of post cancer treatment sexual dysfunction requires identification of this problem and referral to a specialist if necessary. There are several management options available that can greatly enhance quality of life in this often overlooked aspect of post cancer treatment care.

Perceptions, Expectations, Preferences, and Attitudes Toward Premature Ejaculation, Its Diagnosis and Topical Treatment with Fortacin™ Spray: Results from an Expert Panel Discussion.

IntroductionPremature ejaculation (PE) represents the most prevalent male sexual issue. Before beginning treatment, it is essential to discuss the patient’s expectations thoroughly.MethodsHerein, we report the results of an expert panel discussion about perceptions, expectations, preferences, and attitudes towards PE, its diagnosis and treatment. The panel took place in October 2019 and involved 30 Italian urologists experienced in the management of male sexual dysfunction. It aimed at investigating physicians’ points of view about selected aspects of PE management which emerged during the counselling of PE patients over the previous two years. Treatment-related questions were mainly focused on topical treatment with Fortacin™.ResultsOverall, 83.3% of those interviewed declared that most of their patients perceive PE as a bother rather than a disease. The percentage of urologists interviewed perceived that improved subjective control over ejaculation and prolonged intravaginal ejaculatory latency time (IELT) as the main benefit expected by the majority of their patients was 56.5% and 10%, respectively. Eighty percent of urologists reported on-demand regimen as the dosage modality preferred by the majority of their patients and half of them reported the topical route to be the way of administration preferred in most cases. Moreover, 73.3% of urologists reported that adherence to treatment was higher in patients undergoing topical treatment. Finally, 80% of urologists perceived Fortacin to be efficacious in patients with acquired PE and 70% of them perceived its efficacy to be independent from IELT.DiscussionMost patients perceive PE as a bother rather than a disease and mainly advocate an improved control over ejaculation. Fortacin is perceived as efficacious in patients with acquired PE, and independent from IELT.

Pharmacological management of male sexual dysfunction

Male sexual disorders, which are the target of clinical treatment, can be largely divided into erectile dysfunction (ED), ejaculation disorder, infertility, sexual desire disorder, hypogonadism, and other diseases related to penile structure changes, such as Peyronieʼs disease. Current approaches to ED treatment for most men are based on pharmacotherapy. Pharmacotherapy has evolved since the introduction of papaverine and phenoxybenzamine in the early 1980s. Sildenafil, a phosphodiesterase type 5 inhibitor (PDE5I), was the first approved drug for ED. Currently, PDE5Is are the most widely prescribed drugs and have an overall efficacy of 60% to 80% in all categories of ED. Most drugs used in ED are peripheral agents that act on the penis. If a combined treatment with a central nervous system agent and peripheral agents is possible, it may be an effective treatment strategy with higher efficacy. Premature ejaculation (PE) is the most frequent ejaculatory disorder. The absence of a consensus on the definition of PE has served as an obstacle in the investigation of its prevalence and the effectiveness of treatment strategies. Although the etiology of PE is unknown, some biological and psychological hypotheses, including anxiety, penile hypersensitivity, and 5-hydroxytryptamine receptor dysfunction have been suggested. Dapoxetine hydrochloride, a short-acting selective serotonin reuptake inhibitor, was approved for on-demand treatment of PE. Off-label use of antidepressants, topical anesthetic agents, tramadol, and PDE5Is is now available as a pharmacological option. The aim of this review is to describe recent advancements in the pharmacological treatment of male sexual disorders, especially focused on ED and PE.

Роль препаратов растительного происхождения, витаминов и микроэлементов в лечении нарушений мужской сексуальной функции и мужского бесплодия

The male sexual dysfunction and male infertility are worldwide medical and social problems. Herbal therapyand nutrients have used to treat it a long time. The aim of article is to define the components of dietary supplement Antiprost for management of male sexual dysfunction and male infertility according to evidence-based medicine.

A CLINICAL STUDY OF KATAKA CHURNA ON MALE SEXUAL DYSFUNCTION & POOR VISION

Context: Excessive sexual activity or masturbation causes oxidative stress, damaging the inner layer of the eye where the rods and cones are located. Think of rods and cones as molecular strainers that catch light. Oxidative stress of ocular tissues is a major culprit behind vision problems, such as eye floaters, glaucoma and cataracts.
 Aim: To evaluate the efficacy of Kataka churna in the management of Male sexual dysfunction and Poor vision.
 Methodology: 50 patients who have Timira (Poor vision) with associated symptoms Male sexual dysfunction (MSD) had selected for randomised control trial based on inclusion & exclusion criteria.
 Results: The trial drug Kataka churna showed statistically significant results in subjective parameters of poor vision (Timira roga) but insignificant in MSD.
 Key words: Timira, MSD, Kataka churna

What are the benefits and harms of testosterone therapy for male sexual dysfunction?-a systematic review.

The role of Testosterone Therapy (TTh) in the management of male sexual dysfunction remains unclear. Objective of the authors was to systematically review the relevant literature assessing the benefits and harms of TTh in men with sexual dysfunction. EMBASE, MEDLINE, Cochrane Systematic Reviews-Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane HTA, DARE, HEED), Google Scholar, WHO international Clinical Trials Registry Platform Search Portal, CINAHL databases and clinicaltrial.gov were searched systematically in March 2015 and an updated search was performed in March 2016. Randomized and non-randomized comparative studies assessing the benefits and harms of TTh in hypogonadal, borderline eugonadal and eugonadal men suffering from sexual dysfunction were included. Risk of bias and confounding assessments were performed. A narrative synthesis was undertaken. Of the 6410 abstracts identified, 36 studies were judged to be eligible for inclusion, including 25 randomized clinical trials (RCTs) and 11 non-randomized comparative studies (NRCSs), recruiting a total of 4944 patients. RCTs were judged to have low or unclear risk of bias, while NRCSs had high risk of bias and thus, overall quality of evidence was judged to be at least unclear. Based on the evidence mainly provided by the RCTs included in this systematic review, TTh could be considered for men with low or low-normal testosterone levels and problems with their sexual desire, erectile function and satisfaction derived from intercourse and overall sexual life. The exact testosterone formulation, dosage and duration of treatment remain to be clarified, while the safety profile of TTh also remains unclear. TTh could be used with caution in hypogonadal and most probably borderline eugonadal men to manage disorders of sexual desire, erectile function and sexual satisfaction. The overall low-to-moderate evidence quality highlights the need for robust and adequately designed clinical trials.

A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada.

The evaluation and treatment of male sexual dysfunction has developed considerably since the release of sildenafil (Viagra®) as a treatment for erectile dysfunction in 1998.1 There is a societal perception that it is important for men to preserve their sexual function and optimize their sexual performance. This perception, coupled with perpetual innovation in male sexual medicine, has led to many treatment options for male sexual dysfunction, including oral therapies for erectile dysfunction, multiple vehicles for hormonal replacement, shockwave therapy, and penile implants for refractory erectile dysfunction. There are fellowships throughout Canada dedicated to the medical and surgical management of male sexual dysfunction. Medical students and residents across many disciplines are routinely exposed to the evaluation and treatment of men with sexual dysfunction. Unfortunately, despite robust clinical and academic interest in male sexual dysfunction, women with sexual complaints have been largely overlooked.2 There have been limited treatment options, few Canadian role models who specialize in female sexual medicine, and little academic activity in the area of female sexual function. Fortunately, over the past decade there has been an increase in the clinical and academic interest in female sexual function. The times appear to be changing. The International Society for the Study of Women’s Sexual Health (ISSWSH) was established in 2001 to serve as a multidisciplinary international community dedicated to advancing the study of female sexuality. There are published guidelines and position papers that reinforce the practical aspects of female sexual dysfunction (FSD) evaluation and management.3 There has been an important increase in research regarding the impact of cancer and its treatment on female sexual function.4 And finally, there are now U.S. FDA-approved therapies for both low desire and sexual pain that will possibly be available in Canada in the future.5–7 The increase in attention to female sexual function over the past decade can be attributed to a number of factors, including the establishment of ISSWSH, new treatments offering hope, an increase in female sexuality research, and broader societal forces promoting equity in medical practice and research. This review provides a practical, evidence-based guide to the evaluation and management of FSD that is adaptable for clinical practice in Canada. For the purpose of this review, the classification of FSD have been divided into four broad categories: sexual pain, low desire, low arousal, and orgasmic dysfunction. These closely mirror the DSM V classifications of FSD, compromised of: genito-pelvic pain/penetration disorder (sexual pain), female sexual interest/arousal disorder (low desire and low arousal), and female orgasmic disorder (orgasmic dysfunction). 8 These classifications have been chosen instead of the DSM classifications, as many patients will not meet strict criteria but will still benefit from evaluation and management. A symptom-based approach is the most effective means to organize the initial medical evaluation and treatment of women with sexual complaints to encourage collaboration and communication between healthcare providers.

VRUSHYA BASTIS IN THE MANAGEMENT OF MALE SEXUAL DYSFUNCTION.

31Aug 2016 VRUSHYA BASTIS IN THE MANAGEMENT OF MALE SEXUAL DYSFUNCTION. Ravindrasingh N. Rajput , Sukumar Nandigoudar and Rohini Purohit. Assistant professor Dept of Panchakarma LKR Ayurvedic college Gadhinglaj. Reader Dept of Kayachitsa KLE’s ShriBM Kankanawadi Ayurvda Mahavidyalaya Belagavi. Assistant professor Dept of Panchakarma KLE’s ShriBM Kankanawadi Ayurvda Mahavidyalaya Belagavi.

Consensus guidelines on male sexual dysfunction

Male sexual dysfunction (MSD) is a common and distressful condition which is often amenable to counseling and other non pharmacological therapy. These ALLIANCE guidelines are an exhaustive coverage of the counseling and related non-pharmacological methods used for management of MSD. The guidelines discuss various concepts of medical care, including the bio-psychosocial model, patient centered care, couple centered care, therapeutic patient education, shared decision making, minimizing the discomfort of change, and coping skills training, as related to MSD. They go on to describe the ideal environment and prerequisites in which a proper history should be elicited, and physical examination performed. Counseling related to investigations, physical activity and yoga is described. Specific examples of psychotherapy for various sexual disorders are presented to illustrate the usage of counseling. The guidelines discuss cognitive behavioral therapy, couple centered therapy, family therapy, and use of religion in detail. Counseling regarding pharmacological, device and invasive therapy is also covered. The guidelines conclude with a call to enhance community awareness of MSD

Using Wound Drains for the Uncomplicated Penile Prosthesis

No AccessJournal of UrologyOpposing Views1 Oct 2011Using Wound Drains for the Uncomplicated Penile Prosthesis Tobias S. Köhler and Wayne J.G. Hellstrom Tobias S. KöhlerTobias S. Köhler More articles by this author and Wayne J.G. HellstromWayne J.G. Hellstrom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.07.042AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Multi-institutional outcome study on the efficacy of closed suction drainage of the scrotum in three piece inflatable penile prosthesis surgery. Int J Impot Res2005; 17: 535. Google Scholar 2 : Drain cultures in penile prosthesis implants. J Urol2008; 181: S448. Google Scholar 3 : Penile prosthesis cultures during revision surgery: a multicenter study. J Urol2004; 172: 153. Link, Google Scholar 4 : Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev2007; . July 18: CD001825. Google Scholar 5 : Breast augmentation with silicone implants: the role of surgical drainage—report on 502 consecutive patients. Eur J Plast Surg2006; 9: 9. Google Scholar 6 : Is a closed-suction drain advantageous for penile implant surgery?: The debate continues . J Sex Med2011; 8: 601. Google Scholar 7 : Management of penile implant complications. In: The Diagnosis and Management of Male Sexual Dysfunction. Edited by . New York: Igaku-Shoin1996. Google Scholar 8 : Minimally invasive infrapubic penile prosthesis. J Sex Med2008; 5: 15. Google Scholar 9 : Potentiation of wound infection by surgical drains. Am J Surg1976; 131: 547. Google Scholar 10 : A five-year prospective study of 23,649 surgical wounds. Arch Surg1973; 107: 206. Google Scholar 11 : Mentor Alpha 1 inflatable penile prosthesis: patient satisfaction and device reliability. Urology1994; 43: 214. Google Scholar 12 : Hematoma formation following penile prosthesis implantation: to drain or not to drain. J Urol1996; 155: 634A. abstract 1294. Google Scholar Division of Urology, Southern Illinois University School of Medicine, Springfield, IllinoisSection of Andrology, Tulane University School of Medicine, New Orleans, Louisiana© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 186Issue 4October 2011Page: 1187-1189 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tobias S. Köhler More articles by this author Wayne J.G. Hellstrom More articles by this author Expand All Advertisement PDF downloadLoading ...

Anabolic and androgenic activities of Bulbine natalensis stem in male Wistar rats

Aqueous extract of Bulbine natalensis Baker (Asphodelaceae) stem at 25, 50 and 100 mg/kg body weight was investigated for anabolic and androgenic effects in male Wistar rats. Sixty male rats were grouped into four (A-D) consisting of 15 each. Group A (control) was orally treated with 0.5 mL of distilled water for 14 days while groups B, C and D were treated like the control except they received 0.5 mL containing 25, 50, and 100 mg/kg body weight of the extract respectively. All the doses of the extract increased (P <0.05) the testicular-body weight ratio as well as alkaline phosphatase activity, glycogen, sialic acid, protein, and cholesterol content of the testes except the single administration of 100 mg/kg body weight which compared well (P>0.05) with the controls for glycogen and cholesterol. The testicular and serum testosterone concentration were increased except in the 100 mg/kg body weight where the effect on the tissue and serum hormone did not manifest until after the first and seven daily doses respectively. Testicular acid phosphatase activity, serum follicle stimulating and luteinizing hormone concentrations also increased at all the doses except in the 100 mg/kg body weight where the effect on the enzyme and the hormone did not manifest until after seven days. The increases were most pronounced in the 50 mg/kg body weight extract treated animals. The results indicate anabolic and androgenic activities of Bulbine natalensis stem in male rat testes with the 50 mg/kg body weight of the extract exhibiting the highest anabolizing and androgenic acti vities. These activities further support the folkloric use of the plant most especially at 50 mg/kg body weight in the management of male sexual dysfunction in South Africa.

Pharmacological Management of Male Sexual Dysfunction

Pharmacological Management of Male Sexual Dysfunction

Current and future standards in evaluation of erectile dysfunction

Sexual dysfunction and more specifically erectile dysfunction (ED) can be a harbinger of serious occult medical conditions. ED can be considered a clinical manifestation of generalized vascular disease and therefore shares similar risk factors: aging, hypertension, diabetes mellitus, hypercholesterolemia and smoking. The initial evaluation of men with ED should be thorough. Studies of normal and abnormal penile tumescence have led to the discovery of many important pathways. The greatest medical advance in the management of male sexual dysfunction since the identification of androgens have been the discoveries that nitric oxide (NO) is the primary neuro-modulator of penile smooth muscle relaxation and that oral phosphodiesterase type 5 inhibitors enhance erection quality through the NO mechanism. As a consequence of oral pharmacotherapies, the role of invasive diagnostics has diminished. Most guidelines recommend only history, physical exam and limited laboratory testing prior to instituting oral therapies for ED. In 2006 we still have unanswered questions about ED and these will frame the role of future diagnosis and therapy: can lifestyle changes alone improve erectile function; is ED a marker for the development of atherosclerotic heart disease, do lower urinary tract symptoms of benign prostatic hypertrophy and ED share a common pathway?

The evolution of vascular testing in erectile dysfunction

Over the past 20 years, many contributions have been made to our understanding of the mechanisms of erection as a result of penile vascular testing. The greatest medical advances in the management of male sexual dysfunction since the identification of androgens have been two discoveries: 1) that nitric oxide is the primary neuromodulator of penile smooth muscle relaxation, and 2) that oral phosphodiesterase type 5 inhibitors enhance erection quality through the nitric oxide mechanism. As a consequence of oral pharmacotherapies, the role of invasive diagnostics has diminished. Most guidelines recommend only history, physical examination, and limited laboratory testing before instituting oral therapies for erectile dysfunction (ED). We still have unanswered questions about ED. Can lifestyle changes alone improve erectile function? Is ED a marker for the development of atherosclerotic heart disease? What are the specific effects of known cardiovascular morbidities on penile vascular integrity? These questions will frame the role of future penile vascular diagnostics.

The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience

The Sexual Health Inventory for Men (SHIM) is a widely used scale for screening and diagnosis of erectile dysfunction (ED) and severity of ED in clinical practice and research. In reviewing the SHIM-related literature, we sought to provide a compendium of studies in which the SHIM was used, to provide a systematic framework for organizing and evaluating the studies, and to provide a status report on the SHIM and its impact on the management of male sexual dysfunction. Using a Medline search, we found that the SHIM was an integral measure in at least 21 studies on the prevalence of ED, 23 studies on the efficacy of ED interventions, and eight other (mainly correlational) studies. The quantity of research and quality of scholarship on the SHIM provide testimony to its positive impact on understanding and improving male sexual function. These scientific contributions are likely to remain influential in coming years.