Screening For Erectile Dysfunction Research Articles

Handgrip strength, and erectile dysfunction among men with metabolic syndrome attending an institutional primary care clinic in Malaysia: A cross-sectional study.

Erectile dysfunction (ED) is an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between handgrip strength (HGS) and ED, especially among men with a high risk of CVD. This study aimed to determine the prevalence of ED among men aged ≥40 years with metabolic syndrome (MetS) and its association with HGS. A cross-sectional study at an institutional primary care clinic in Malaysia was conducted between June 2021 and October 2021. HGS and erectile function were assessed using a hand dynamometer and International Index of Erectile Function (IIEF-5) questionnaire, respectively. Multiple logistic regression analyses were performed to determine the association between sociodemographics, clinical characteristics, and HGS with ED. A total of 334 participants were recruited. The prevalence of ED was 79% (95% confidence interval [CI]: 0.75-0.84). ED was associated with elderly aged ≥60 years (odds ratio [OR] 3.27, 95%CI: 1.60-6.69), low HGS (OR 15.34, 95%CI: 5.64-41.81) and high total cholesterol (OR 0.36, 95%CI: 0.16-0.78). In conclusion, age above 60 years and those with low HGS are at higher risk of ED. Thus, robust screening of ED among men with MetS and improving muscle strength and physical fitness may be warranted.

Evaluation of Lower Urinary Tract Symptoms in Males and Urinary Incontinence in Females in Primary Health Care in Greece.

Background and Objectives: The significant prevalence of Lower Urinary Tract Symptoms (LUTS), erectile dysfunction (ED), and associated adverse effects calls for increased attention in primary care settings. In Greece, there is a lack of sufficient data for LUTS and ED screening in primary care. Therefore, the aim of our study was to estimate the prevalence of LUTS and ED, identify associated risk factors, and evaluate their impact on quality of life among adult primary healthcare users aged 40 years and older in Crete, Greece. Materials and Methods: A cross-sectional study was conducted to explore the prevalence of LUTS and ED in 1746 primary health care users visiting rural primary health care practices in Crete, Greece. Participants underwent a comprehensive evaluation including demographic parameters, screening for LUTS utilizing the validated International Prostate Symptoms Score (IPSS) questionnaire and for ED using the International Index of Erectile Function (IIEF-5), in males, and for urinary incontinence in women with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Participants with a prior diagnosis of LUTS or ED were excluded (n = 183). Results: Out of 536 participants finally included (n = 1746 screened), 32% of males and 36% of females exhibited moderate to severe LUTS. Following adjustments, we identified advanced age, retirement, and the presence of diabetes type 2 as factors associated with the occurrence of LUTS in men. Patients with LUTS also had a substantially increased likelihood of experiencing ED. Moreover, it was observed that women with hypertension or diabetes type 2 and lower education levels face an increased likelihood of developing LUTS, which adversely affects their quality of life. Conclusions: In conclusion, the findings of this study reveal a high occurrence of LUTS and ED in adults aged 40 years and older who utilize primary healthcare services, with a negative impact on their quality of life.

Association between erectile dysfunction and cardiovascular risk factors in a Nigeria tertiary hospital

INTRODUCTION: Erectile dysfunction has adverse effects on the marital harmony and self-esteem of affected persons. It is shrouded in shame in our environment, hence affecting self-reporting of the condition. It is linked to CVDs in its etiology. The objective was to determine the relationship between erectile dysfunction (ED) and cardiovascular risk factors to recommend them as indicators for screening for ED in our environment.
 METHODS: This was a cross-sectional analytical study of 243 men at a tertiary hospital in Nigeria. Participants were recruited by systematic random sampling, excluding those on aphrodisiacs. Erectile dysfunction was measured using the International Index of Erectile Function (IIEF-5), and ED was defined as a score <17. CVD risk factors were obtained from history and examination. Univariate analysis and logistic regressions were used to elicit associations between ED and cardiovascular risk factors.
 RESULTS: The prevalence of ED was 47.3%. Erectile dysfunction was associated with increasing age (χ2=27, p<0.01), harmful alcohol use (χ2=3.08, p= 0.079), diabetes (χ2=8.29, p=0.04), and hypertension (χ2=12.28, p =0.01) following bivariate analysis. However, only advanced age (aOR=0.04, 95% CI: 0.00-0.54, p = 0.014) and harmful alcohol use (aOR = 0.37, 95% CI: 0.04-0.97, p=0.043) were independently associated with ED after binary logistic regression.
 CONCLUSION: The prevalence of ED is high high. It is associated with age, harmful alcohol use, diabetes mellitus, and hypertension, hence the need to screen for ED, especially in the presence of these factors.

Erectile dysfunction prevalence and associated factors in men living with HIV from Western Turkey: A cross-sectional study.

The majority of people living with HIV in our country are younger men. However, limited data exist for the sexual health of these patients. Knowledge of the epidemiology in this population may improve health outcomes across the continuum of HIV care. The aim of this study was to determine the prevalence of erectile dysfunction (ED) and its association with some clinical and laboratory factors. A cross-sectional study was conducted using random sampling in men living with HIV (MLWH) at a tertiary hospital in Turkey. Patients were asked to fill out the five-item International Index of Erectile Function (IIEF-5), and blood was collected for HIV viral load, CD4+ T lymphocyte count, lipids and hormone levels to assess biological aspects at the same clinical visit. A total of 107 MLWH were recruited. Mean age was 40.4 ± 12.4 years. ED was found in 73.8% (n = 79) of the participants. Severe ED was found in 6.3%, moderate in 5.1%, mild-moderate 35.4%, mild 53.2% of the participants, respectively. The mean age of men with erectile dysfunction was 42.5 ± 12.5 years, while those without erectile dysfunction were 34.5 ± 10years (p:0.00). ED was detected more frequently in cases with high Low Density Lipoprotein (LDL) levels (p:0.003). There was no statistically significant difference between ED presence and having hormone abnormality. There was a moderate, negative correlation between age and ED score (r: -0.440, p < 0.001). A negative and low correlation was found between triglyceride level and ED score (r: -0.233, p:0.02). The only predictive variable was age in the multivariate analysis [B: -0.155 (95% CI -0.232 to -0.078), p: <0.001]. Our study revealed a high prevalence of ED in the MLWH cohort. Age was found to be the only factor associated with ED. HIV clinicians should consider routine ED screening with validated measures as a part of the follow-up scheme to improve integrated wellbeing in MLWH.

A multi-faceted intervention to improve screening of erectile dysfunction for men with diabetes mellitus in public health clinics: A pilot study.

Erectile dysfunction (ED) is common in men with diabetes and is associated with coronary artery disease and psychological distress. However, discussion of ED in primary care consultations is uncommon. Interventions, such as audit and feedback, mandate of management, and workshop on men's sexual health, have been proposed to improve ED screening in public health clinics. This study aimed to pilot test a multi-faceted intervention to increase ED screening among men with diabetes and to improve knowledge and confidence in ED screening among primary healthcare providers (PHPs). We conducted an interrupted time-series quasi-experimental study with PHPs at public health clinics in Perak, Malaysia from February 2019 to February 2020. Doctors, nurses, and assistant medical officers involved in diabetes care were recruited. The intervention was conducted between July and September 2019 and comprised two phases: audit and feedback, and mandate from management (phase 1), and an interactive face-to-face workshop (phase 2). The primary outcome measure was monthly ED screening rate, and the data were retrieved from health records and the clinical diabetes registry. The PHPs completed a questionnaire on ED knowledge and confidence in ED screening before and after the workshop. The total number of attendances by patients with diabetes was 50,325 during the study period, of which 21,413 were by men. A total of 30 PHPs participated in the training workshop: 7 (23.3%) doctors, 12 (40%) medical assistants, and 11 (36.7%) nurses. The mean duration of employment at a health clinic was 7 ± 5 years. The majority of the participants were male (56.7%), Malay (80%), married (76.7%), and had no experience with working in a urology department (76.7%). There was a significant improvement in the mean knowledge score (39.0 ± 11.4 vs. 63.6 ± 6.2, p<0.001) and median confidence level in ED screening from 2 (IQR 2-3) to 4 (IQR 4-4) after the workshop (p<0.001). After phase 1, the rate of ED screening increased from a baseline of between 10.3% (February 2019) and 12.7% (June 2019) before intervention to between 15% (July 2019) and 18.9% (September 2019) and was maintained between 18% (October 2019) and 17.9% (December 2019) after phase 2. Subsequently, the ED screening rate declined from 14.6% (January 2020) to 10.9% (February 2020). This study found that audit and feedback with mandate from management increased ED screening and detection rate. The workshop improved the participants' knowledge and confidence in ED screening but did not further increased ED screening. The improved practice was sustained for 6 months after the intervention, while the detection rate of ED persisted. We propose regular audit and feedback with mandate from management to sustain the practice of ED screening in men with diabetes.

Opinions, Attitudes, and Perceptions in Relation to Erectile Dysfunction and Premature Ejaculation in the Undiagnosed Spanish Male Population. Results of the PANDORA Project

BackgroundApproximately 43% of Spanish men report experiencing premature ejaculation (PE) at some point in their lives and 12.1% suffer from erectile dysfunction (ED), of whom only 16.5% have seen a doctor. Despite this, ED and PE remain undiagnosed among a supposedly healthy segment of the population. AimTo assess the general knowledge of a representative population of healthy Spanish males of the symptoms, treatment, and expectations related to ED and PE. MethodsThis was a descriptive study based on an online questionnaire in which 2,515 males aged 25–75 years with no history of ED and/or PE presented their perception of aspects related to symptoms, diagnosis, treatment, and expectations in ED and PE. Main Outcome MeasuresThe study provided an evaluation of the knowledge, attitude, and underdiagnosis of ED and/or PE in healthy males and the approach taken by urology specialists and other disciplines. ResultsThe survey was completed by 2,515 healthy males, including over 80% of those who had completed secondary or higher education. 60% of the sample had never seen a urologist and 59% and 62% of the participating men responded correctly to the statements about PE and ED, respectively. Their lack of knowledge of the therapeutic alternatives was clear (74% and 76% of the panel were unaware of the existence of effective treatments for ED and PE, respectively). Despite the initiative shown by some participants in seeking information about each condition (10.3% for ED; 16.7% for PE), only 4.7% of them had been questioned about ED by a medical practitioner (1.9% for PE). The underdiagnosis rate stood at 3.5% for ED (5.6% participants >65 years) and at about 10% for PE. Clinical ImplicationsThese results will represent a point of departure for establishing some recommendations to improve the detection and treatment of these disorders. Strengths & LimitationsThis is the first study of its kind in Spain to analyze the underdiagnosis of ED and/or PE inferred from data reported by a population of healthy males. Screening for ED was performed with a validated questionnaire. However, the rest of the research was conducted using adaptations of validated questionnaires or a self-designed questionnaire based on and in consultation with a group of experienced andrologists. ConclusionPeople need to have greater knowledge of both the conditions and the related false myths to make sure that they are familiar with the existence of drug treatments and socio-sanitary interventions. Primary care physicians and urologists should also be more proactive in routine visits in order to achieve better management of ED and PE.Prieto-Castro R, Puigvert-Martínez AM, Artigas-Feliu R, et al. Opinions, Attitudes, and Perceptions in Relation to Erectile Dysfunction and Premature Ejaculation in the Undiagnosed Spanish Male Population. Results of the PANDORA Project. J Sex Med 2020;17:1495–1508.

ASSOCIATION OF ERECTILE DYSFUNCTION AND PREMATURE EJACULATION IN MEN WITH CHRONIC PROSTATITIS

Background and objective Although several studies have reported that sexual dysfunction is associated with chronic prostatitis (CP), specific differences in self-reported questionnaires and correlation with CP are not well-known. This study aimed to evaluate the prevalence and correlation of sexual dysfunction in men with CP. Material and methodsThis cross-sectional study included 892 men who visited our health care center, who were then divided into two groups. In Group 1, subjects are characterized with National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) pain score ≥4, and Group 2 subjects are characterized with NIH-CPSI<4. Intravaginal Ejaculation Latency Time, Premature Ejaculatory Diagnostic Tool (PEDT), Male Sexual Health Questionnaire-ejaculation, International Index of Erectile Function (IIEF), and IIEF-5 were self-reported by participants. Total testosterone (TT) level was also checked. Data obtained were compared between the groups and the relationships identified. ResultsThe mean age was 52.8±7.3 years, and CP was prevalent in 136 (15.2%) of the 892 participants. All questionnaire scores showed worse results in Group 1 compared to those in Group 2 (p<0.05). In total, the prevalence of erectile dysfunction (IIEF-5≤21) and premature ejaculation (PEDT≥9) were 508 (56.3%) and 290 (32.5%), respectively. A higher prevalence of erectile dysfunction (71.3% vs. 53.6%, p<0.001) and premature ejaculation (44.8% vs. 30.3%, p=0.001) was identified in Group 1 than in Group 2. By correlation analysis, IIEF-5 (r=−0.208, p=0.015) and TT (r=−0.331, p=0.011) showed correlation with NIH-CPSI pain score in Group 1. ConclusionThe prevalence and severity of erectile dysfunction and premature ejaculation were higher in Group 1. Moreover, the IIEF-5 showed correlation with NIH-CPSI pain score. These results indicate that screening for erectile dysfunction and premature ejaculation in men with CP is useful for early detection of comorbidities.

121 Relationship between Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Erectile dysfunction

The relationship of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with erectile dysfunction (ED) has been investigated in a few studies. However, previous studies are limited by having a small participant number or minimal adjustment for potential confounding factors including testosterone and metabolic syndrome. Therefore, the current data are insufficient to support routine screening of ED in men with CP/CPPS or CP/CPPS in men with ED. This study aims to evaluate the relationship between ED and CP/CPPS. A total of 8,261 men in their 40s and 50s were included. The National Institutes of Health-Chronic Prostatitis Symptom Index(NIH-CPSI), and the International Index of Erectile Function-5(IIEF) were used for symptoms assessment. Symptoms were classified as a “mild prostatitis-like symptom” if respondents reported perineal or ejaculatory pain and had a NIH-CPSI pain score of ≥4 and <8; the symptoms were classified as moderate to severe if the pain score was ≥8 according to previous reports. Moderate to severe ED was defined as IIEF<12. A full metabolic work-up and serum testosterone level checks also performed.

The global prevalence of erectile dysfunction: a review.

To evaluate the global prevalence of erectile dysfunction (ED); as well as its association with physiological and pathological ageing by examining the relationship between ED and cardiovascular disease (CVD), benign prostatic hyperplasia (BPH), and dementia. We also aimed to characterise discrepancies caused by the use of different ED screening tools. The Excerpta Medica dataBASE (EMBASE) and Medical Literature Analysis and Retrieval System Online (MEDLINE) were searched to find population-based studies investigating the prevalence of ED and the association between ED and CVD, BPH, and dementia in the general population. The global prevalence of ED was 3-76.5%. ED was associated with increasing age. Use of the International Index of Erectile Function (IIEF) and Massachusetts Male Aging Study (MMAS)-derived questionnaire identified a high prevalence of ED in young men. ED was positively associated with CVD. Men with ED have an increased risk of all-cause mortality odds ratio (OR) 1.26 (95% confidence interval [CI] 1.01-1.57), as well as CVD mortality OR1.43 (95% CI 1.00-2.05). Men with ED are 1.33-6.24-times more likely to have BPH then men without ED, and 1.68-times more likely to develop dementia than men without ED. ED screening tools in population-based studies are a major source of discrepancy. Non-validated questionnaires may be less sensitive than the IIEF and MMAS-derived questionnaire. ED constitutes a large burden on society given its high prevalence and impact on quality of life, and is also a risk factor for CVD, dementia, and all-cause mortality.

Performance of the International Index of Erectile Function tool in men with epilepsy

BackgroundApproximately 18 million men suffer from some type of erectile dysfunction (ED), which is primarily attributed to age, comorbid health conditions, or medications. Men with epilepsy encounter all of these issues, yet ED literature and research in men with epilepsy is not yet robust. The purpose of this study was to test the utility of a validated ED screening tool in a population of men with epilepsy, as well as to assess additional parameters that may contribute to ED in this specific patient population. The secondary aim of this study was to determine the prevalence of noncompliance of epilepsy medication which may be due to a perceived relationship with ED. MethodsThis was a prospective pilot study to validate the International Index of Erectile Function (IIEF) in men with epilepsy. Enrolled men, between the ages of 18–45 years, were given an anonymous online survey that included the IIEF, as well as additional elements pertinent to their seizures and related treatment, including medication compliance. ResultsA total of 164 men completed the IIEF survey. Of these, 28% of respondents indicated the presence of ED, for which specific treatment might be warranted. The IIEF has 5 subscales; mean scores for each subscale are the following: ED 17.48/30, orgasmic function 6.2/10, sexual desire 6.72/10, intercourse satisfaction 8.98/15, and overall satisfaction 5.18/10. Four additional variables were added to specify the needs of men with epilepsy. ConclusionThe IIEF can be administered to men with epilepsy. The addition of specific targeted questions in this patient population may also provide better understanding and facilitate an open dialog about how male sexual function relates to epilepsy and/or treatment thereof.

Knowledge, Attitude, Confidence, and Barriers in the Practice of Erectile Dysfunction Screening among Primary Health-Care Providers in Taiping Perak, Malaysia

Background: Erectile dysfunction (ED) is a common health problem and has clinical importance. it is well documented that ED is associated with coronary heart disease. However, the practice of ED screening is poor in primary care settings. Objectives: To assess primary health-care providers' knowledge and attitude toward ED and to determine the confidence and barriers in the screening of ED. Materials and Methods: A cross-sectional study using self-administered questionnaires was conducted at 11 government health clinics in Taiping Perak in 2018 involving all health-care providers who run the outpatient and noncommunicable disease unit. SPSS (version 25) statistical package was used to analyze the data. Mann–Whitney U-test, Kruskal–Wallis test, and Chi-square test were employed. Results: A total of 77 primary health-care providers participated in this study. The median age of the participants was 31 years (interquartile range 7). A total of 38 (49.4%) participants scored above the median knowledge. Participants who were doctors, users of clinical practice guide in ED, confident in ED screening, and perceived adequate training scored higher in knowledge (P ≤ 0.05). Smoking as a cause of ED (98.7%) recorded the highest percentage of correct responses, whereas the prevalence of ED (18.2%) recorded the lowest. All participants perceived ED as an important health issue and felt that proper treatment is required. Only 16 (20.8%) participants had confidence in ED screening practice. Lack of training in ED screening and assessment was the barrier that significantly affects the confidence of practice (P = 0.012). Conclusion: The knowledge on ED and confidence in its screening were unsatisfactory among the primary health-care providers. Our work suggests the requirement to equip health-care professionals with adequate training on ED screening, assessment, and management for early prevention of cardiovascular disease and improvement of men's quality of life.

Erectile dysfunction in obstructive sleep apnea patients: A randomized trial on the effects of Continuous Positive Airway Pressure (CPAP).

ObjectivesObstructive sleep apnea (OSA) is among the least studied risk factors for erectile dysfunction (ED). We aimed to determine ED prevalence in newly-diagnosed OSA patients, describe their main characteristics and assess continuous positive airway pressure (CPAP) effects on ED.MethodsCross-sectional study assessing ED prevalence in OSA patients and open-label, parallel, prospective randomized controlled trial evaluating 3-month CPAP treatment effects on sexual function, satisfaction, and psychological, hormonal and biochemical profiles. Male patients newly diagnosed with moderate/severe OSA (apnea-hypopnea index >20 events·h−1), aged 18–70 years, attending the sleep unit of a Spanish hospital during 2013–2016 were considered. A total of 150 patients were recruited (75 randomized ED patients). ED was defined as scores <25 on International Index Erectile Function 15 test. Wilcoxon’s matched-pairs signed-ranks and rank-sum tests were used.ResultsED prevalence was 51%. Patients with ED were older (p<0.001), had greater waist-to-hip ratios (p<0.001), were more frequently undergoing pharmacological treatment (p<0.001) and had higher glucose levels (p = 0.024) than non-ED patients. Although significant increases in erectile function (mean(SD) change: +4.6(7.9); p = 0.002), overall satisfaction (+1(2.2); p = 0.035), and sexual satisfaction (+2.1(4.3); p = 0.003) were found after CPAP treatment, only differences in sexual satisfaction (p = 0.027) and erectile function (p = 0.060) were found between study arms. CPAP treatment did not impact psychological, hormonal or biochemical profiles.ConclusionsThis study confirmed the relationship between OSA and ED, suggesting the potential usefulness of ED screening in OSA patients, but could not determine conclusively whether CPAP is an effective stand-alone ED treatment, regardless of positive results on sexual satisfaction.Trial registrationClinicalTrials.gov NCT03086122

Diagnosis of erectile dysfunction can be used to improve screening for Type 2 diabetes mellitus.

AimsTo assess the diagnostic accuracy of four undiagnosed Type 2 diabetes mellitus risk scores accounting for erectile dysfunction status.MethodsThis was a population‐based cross‐sectional study. Type 2 diabetes was defined according to a oral glucose tolerance test and self‐reported physician diagnosis. Erectile dysfunction was defined according to the answer to the question, ‘Have you had difficulties obtaining an erection in the last 6 months?’ (yes/no). The risk scores used were the FINDRISC, LA‐FINDRISC, American Diabetes Association score and the Peruvian Risk Score. A Poisson regression model was fitted to assess the association between Type 2 diabetes and erectile dysfunction. The area under the receiver‐operating characteristic curve was estimated overall and by erectile dysfunction status.ResultsA total of 799 men with a mean (sd) age of 48.6 (10.7) years were included in the study. The overall prevalence of Type 2 diabetes was 9.3%. Compared with healthy men, men with Type 2 diabetes had 2.71 (95% CI 1.57–4.66) higher chances of having erectile dysfunction. Having excluded men aware of Type 2 diabetes status (N=38), the area under the receiver‐operating characteristic curve of three of the risk scores (not the American Diabetes Association score) improved among those who had erectile dysfunction in comparison with those who did not; for example, the area under the receiver‐operating characteristic curve of the LA‐FINDRISC score was 89.6 (95% CI 78.7–99.9) in men with erectile dysfunction and 76.5 (95% CI 68.5–84.4) overall.ConclusionsIn a population‐based study, erectile dysfunction was more common in men with Type 2 diabetes than in the otherwise healthy men. Screening for erectile dysfunction before screening for Type 2 diabetes seems to improve the accuracy of well‐known risk scores for undiagnosed Type 2 diabetes.

Prevalence of, and risk factors for erectile dysfunction in male type 2 diabetic outpatient attendees in Enugu, South East Nigeria.

Context:Erectile dysfunction (ED) is a strong predictor of poor quality of life in men with type 2 Diabetes mellitus (T2DM). Several studies evaluating ED in men with diabetes mellitus have been carried out, but few of these have been done in Nigeria. In Enugu, South East Nigeria, paucity of studies on this subject was observed.Aims:This study aims to determine the prevalence and predictors of ED in men with T2DM attending the diabetes clinics.Settings and Design:A descriptive cross-sectional study of men with T2DM in UNTH and Saint Mary's Hospital, Enugu, was carried out. The systematic sampling method was used to recruit participants.Subjects and Methods:Data collection from participants and their hospital records was done using semi-structured questionnaire. ED was assessed using the 5 items, international index of erectile function questionnaire.Statistical Analysis Used:Data analysis was done using SPSS version 20 and results presented as texts and tables. P value was set at <0.05.Results:A total of 325 participants with mean age of 57.8 ± 13.2 years were involved out of which 94.7% had ED. The proportion of participants with ED had increased with its severity. Predictors of ED included poor glycemic control, longer duration of diabetes, overweight/obesity, and older age. Poor ED health-seeking behavior and treatment were noted.Conclusions:The prevalence of ED is high. Lifestyle interventions targeted at improving glycemic control and weight loss may reduce the burden of this complication. We recommend objective ED screening using standard but brief instruments as part of routine evaluation of men with T2DM.

Erectile dysfunction in patients with plaque psoriasis: the relation of depression and cardiovascular factors.

Psoriasis is a chronic inflammatory skin disease and seems to be associated with erectile dysfunction (ED). ED is a predictor of future cardiovascular disease. It is important to identify ED early and investigate cardiovascular problems in psoriasis patients. The sample consisted of 191 psoriasis patients and 191 healthy men. One hundred and one of 191 (52.9%) patients with psoriasis were indicative of ED, compared with 40.3% in control group, reflecting an age-adjusted odds ratio of 1.965 in favor of the psoriasis group. A univariate analysis in the psoriasis group indicated that age, hypertension, hyperlipidemia, diabetes mellitus and depressive symptoms were the risk factors for ED. The multivariate logistic regression model indicated that increasing age, hypertension, hyperlipidemia and depressive symptoms were independent risk factors for ED in psoriasis. The more severe depressive symptoms increased the risk of ED and especially moderate-severe ED. The diagnosis of ED may help prevent emotional and physical discomfort in men and aid in identifying reversible cardiovascular risk factors. Screening of ED may become a part of routine care in the management of psoriasis patients.

Can thromboembolic risk be associated with erectile dysfunction in atrial fibrillation patients?

Erectile dysfunction (ED) is highly prevalent in patients with diseases of cardiovascular system, including patients with atrial fibrillation (AF). Reasons for this high co-prevalence include endothelial dysfunction, inflammation, oxidative and emotional stress associated with AF. Association of AF-induced prothrombotic state and possible microthrombi in penile arteries with ED remains unclear. The present study aims to assess if probability of AF-associated risk of peripheral thromboembolism may be associated with ED in AF patients. Probability of thromboembolic complications was assessed with two commonly used risk scores CHADS₂ and CHA2DS₂-VASc in a group of continuous AF patients. All patients were also asked to fill an IIEF-5 questionnaire designed for screening for ED. Mean CHADS₂ score in the whole study group was 1.1 ± 1.0 points and CHA₂DS₂- -VASc was 1.5 ± 1.4 points. ED was present in 57.4% of the 129-person study population. In patients with ED, both CHADS₂ (0.9 ± 1.0 vs. 1.3 ± 1.1; p = 0.03) and CHA₂DS₂-VASc (1.2 ± 1.1 vs. 1.8 ± 1.5; p = 0.03) scores were significantly higher than in the group without dysfunction. After dividing the patients according to age into groups younger than 65 years vs. ≥ 65 years, observed correlation was no longer significant in the younger group (p > 0.05). In patients ≥ 65 years, in whom the risk scores are routinely used, dysfunction both CHADS₂ (1.1 ± 0.9 vs. 2.0 ± 0.9; p = 0.02) and CHA₂DS₂-VASc (2.3 ± 1.1 vs. 3.4 ± 1.3; p = 0.04) scores were higher in the group with ED. Erectile dysfunctions in AF patients are associated with elevated cardioembolic risk. We postulate that the diagnosis of ED should be considered an additional marker of prothrombotic state, and may be useful in clinical decision-making, especially in patients ≥ 65 years old.

New treatments for erectile dysfunction

Erectile dysfunction (ED) is common in men with diabetes and is associated with microvascular disease, maladaptation to chronic illness, poor quality of life, and increased levels of diabetes-specific health distress. Traditionally, most diabetologists were poor at asking about ED and patients themselves are not always forthcoming with information, given the embarrassing nature of the disease. However, times are changing and the inclusion of screening for ED in Quality and Outcomes Framework and current general practice templates emphasises its current importance. Licensed treatments have been limited in their application towards the provision of symptomatic relief and are offset by adverse effects, intolerance, limited effectiveness and contraindications in the presence of co-existent cardiovascular disease. This review critically considers the utility of novel treatments for ED in diabetes that have been developed to overcome these barriers.

Prevalence, correlates, attitude and treatment seeking of erectile dysfunction among type 2 diabetic Chinese men attending primary care outpatient clinics.

To investigate the prevalence, correlates, attitude and treatment seeking behavior of erectile dysfunction (ED) in type 2 diabetes mellitus (T2DM) patients in the primary care setting, a multi-center cross-sectional survey using a structured anonymous self-administered questionnaire was performed in 10 general outpatient clinics. Of the 603 subjects (91% response rate), the prevalence of ED men, as defined by the International Index of Erectile Function, was 79.1%. Most subjects had mild ED (28.9%), followed by mild-to-moderate ED (27.9%), then moderate ED (13.4%) and severe ED (9%). Nearly 55% of those with ED did not consider themselves as having ED. Less than 10% of them had ever sought medical treatment, although 76.1% of them wished to receive management from doctor(s) should they be diagnosed with ED. They considered the most important management from doctors to be clinical assessment (41.7%), followed by management of potential underlying cause (37.8%), referral to specialist (27.5%), education (23.9%), prescription of phosphodiesterase type 5 inhibitors (16.9%) and referral to counseling service (6.7%). The prevalence of ED was strongly associated with subjects who thought they had ED (odds ratio (OR) = 90.49 (20.00–409.48, P< 0.001)) and were from the older age group (OR = 1.043 (1.011–1.076, P = 0.008)). In conclusion, ED is highly prevalent among T2DM men. The majority of them wanted management from doctors should they have ED, but only a minority would actually voice out the request. Screening of ED among T2DM men using structural questionnaire allowed the diagnosis of more than half of the ED cases, which otherwise would have gone undiagnosed.

Erectile Dysfunction

Erectile Dysfunction

The expanding sphere of primary prevention for coronary artery disease in persons with erectile dysfunction.

To the Editor, Erectile dysfunction (ED) is a condition of multifactorial causes. Recently, Schwatrz and Kloner published an article on ED and heart disease that brought to light the cardiovascular implications of ED.1 The relation of ED as an early clinical sign of cardiovascular disease is indeed worth future investigation considering the fact that ED occurs 3-5 years prior to the initial acute coronary event. The second Princeton Consensus Conference in 2004 recognised ED as an early sign of cardiovascular disease and classified patients into low, intermediate and high risk groups. They also provided algorithms for approach and management of these patients.2 Recently, a meta-analysis of cohort studies showed that the presence of ED increased the risk for CAD (relative risk: 1.48, 95% CI: 1.25-1.74; p<0.001).3 This has great significance for those involved in prevention - both at primary and secondary levels. We would therefore, like to highlight the role of exercise training in primary and secondary prevention of coronary artery disease (CAD) among those with ED and also the role of the urologist in aiding prevention of CAD. ED has been associated with CAD in both diabetics,2 and also in the general population.4 Various factors like type 2 diabetes mellitus, atherosclerosis, smoking, and sedentary lifestyle have been attributed to ED.5 Elevated inflammatory markers, endothelial dysfunction, lack of physical activity, and obesity have been found to lead to ED.5,6 Therefore, it can be hypothesized that prevention of these factors could not only prevent ED but also in the long run, CAD. La Vignera et al. recently published a review with one of their aims being to sensitize health practitioners to the role of physical activity in ED.6 They highlighted the importance of physical activity and exercise training on inflammatory markers, endothelial function and obesity and how they affected ED. They also reported moderate physical activity (>150 minutes/week) was sufficient for maintaining proper erectile function. Data from studies on exercise training have shown that exercise training increased the number of endothelial progenitor cells and increased the levels of total testosterone. The levels of testosterone were, however, dependent on the duration of exercise.6 This suggests that individuals with ED, in whom nonvascular causes have been excluded, are likely to benefit from exercise training. However, more research is required with regard to the intensity, duration, and the long term benefits of exercise on ED and its role of in preventing CAD among those with vasculogenic ED. Other strategies like lifestyle modifications also play a vital role in improving sexual function thereby also controlling the risk factors for CAD.7 Growing evidence suggests that lifestyle modifications are equally effective as pharmacological interventions for cardiovascular risk factors in improving erectile function (standardized difference in means of International Index of Erectile Dysfunction are 2.40 (95% CI, 1.19-3.61) vs. 3.07 (95% CI, 1.84-4.30) for lifestyle modifications and pharmacotherapy respectively).8 This cycle of ED leading onto CAD brings to light a new frontier for primary prevention. Therefore, the need for screening for vasculogenic ED in the community would probably be the next step in primary prevention of CAD. This has been supported in a recent population based study among diabetics, in which it was seen that screening for ED along with the traditional risk factors for cardiovascular disease could improve the identification CAD.9 Early diagnosis and referral of patients with vasculogenic ED to cardiologists and exercise specialists for further evaluation and exercise training is therefore the need of the hour. Integration of specialists like urologists will also be required for the general screening. Large scale population studies will be needed to identify the risk factors for ED and CAD in the community and strategies will need to be adopted for promoting preventive strategies and exercise training in these patients.