Screening For Erectile Dysfunction Research Articles

Erectile dysfunction and testosterone screening with prostate specific antigen screening at age 40: are these three gender specific determinants additive for overall men’s heath and do they improve traditional non-gender specific determinants to lessen ca

Assess support for a recommendation to add screening for both erectile dysfunction (ED) and hypogonadism to the initial medical evaluation of young-to-middle aged (≥ 40 years of age) men in light of recent guidelines suggesting prostate-specific antigen screening occur at that age. A search of literature published from 1998 to 2009 was performed. Search terms included: ED combined with coronary artery disease (CAD), metabolic syndrome and hypogonadism, hypogonadism and ED, hypogonadism, ED and mortality. Articles were evaluated according to the Center of Evidence-Based Medicine. Both retrospective and prospective evaluations have demonstrated a strong relationship between ED, established cardiovascular risk factors, CAD and the potential occurrence of cardiovascular events. Low testosterone levels are associated with ED. Low serum total testosterone is an independent risk factor for both metabolic syndrome and type 2 diabetes and all-cause mortality. Traditionally, ED and testosterone levels have been considered mainly, if not exclusively, in the context of sexual health. The results briefly summarised herein and other recent reviews suggest that ED and hypogonadism are signals of future all-cause mortality and overall health status and thus move these evaluations into the broader arena of public health. Screening for ED and hypogonadism provide 'gender-specific determinants' to assess general metabolic and cardiovascular health risks in men. It is the opinion of the authors that this screening be performed in addition to the well-established non-gender-specific screening tests of lipids, blood pressure, obesity and serum glucose.

Attitudes des médecins généralistes et endocrinologues face à la dysfonction érectile du patient diabétique : enquête auprès de 130 patients

To assess the prevalence, the severity and expectations regarding erectile dysfunction (ED) in diabetic patients, then to investigate how general practitioners (GP) and endocrinologists manage this disorder. A questionnaire was given during 5 weeks to every diabetic patient addressed to the endocrinology department in order to assess erectile function (IIEF5), patient's bother and expectations to be treated, and the management of ED by GP and endocrinologists and differences in management between male and female doctors. One hundred and thirty questionnaires were available. Mean age was 57.5 and the mean IIEF5 score was 13.6. Twenty-two patients (16.9%) reported an IIEF5 score less than 5 and 75 patients (57,6%) reported an IIEF5 between 5 and 20. Eighty-six patients declared ED (66.2%). In these patients, 76 (88.4%) sought for a medical treatment and 11 (12.8%) received a treatment for ED. Endocrinologists were more active than GP in the screening of ED (59.5% vs 19.4%, P=0.001) but prescribed a treatment less often (14.3% vs 45.2%, P=0.008). Female doctors seemed less active in ED management (29.3% vs 13.3%, NS). This study highlighted the lack of ED management by GT and endocrinologists in diabetic patients in spite of ED's frequency and patients' expectations.

Patterns and Their Correlates of Seeking Treatment for Erectile Dysfunction in Type 2 Diabetic Patients

Diabetic patients are at high risk of having erectile dysfunction (ED), but their doctors rarely pay attention to this association. To evaluate the treatment-seeking patterns and their correlates for ED in type 2 diabetic patients. A questionnaire containing Sexual Health Inventory for Men and questions inquiring treatment-seeking patterns was mailed or given to 4,040 subjects who had visited our endocrinology outpatient department for diabetes during January 2004 to May 2006. The prevalence of being bothered and having interest in treatment, and the percentage having sought treatment in regard to ED and their correlates with age and ED severity. Of the subjects with questionnaire completed, 83.9% (708/844) had ED. Among the subjects with different severity of ED, the moderate group had the highest percentages regarding prevalence of being bothered (89.4%), having interest in treatment (78.5%), and having sought treatment (46.2%). Of all the subjects, only 14.2% had ever visited Western physicians, whereas embarrassment and misinformation about ED treatment were the leading reasons for never doing so. Over half (56.6%) of those with ED wished to discuss ED problem with their doctors, and of them 90.4% wished the doctors to initiate to broach this issue. The prevalence of ED and the concerns about it were high in these diabetic patients. ED severity was the major determinant of their treatment-seeking decision, whereas only few of them had ever sought professional help. Routine screening of ED in diabetic patients is recommended.

Erectile dysfunction in patients with diabetes mellitus: results of epidemiological monitoring

Aim. Screening for erectile dysfunction (ED) in patients with type 1 and 2 diabetes mellitus. Materials and methods. The study included 611 patients with type 1 (n=276) and 2 (n=335) diabetes mellitus. The control group comprised 70 patients.The methods used were a questionnaire survey, HbA1c measurement, evaluation of renal and cardiovascular function, examination of ocularfundus, lower extremities and genital organs. Differences were considered significant at p

Management of Erectile Dysfunction in General Practice

In recent years, the availability of effective oral pharmacological treatment for erectile dysfunction (ED) has revolutionized its management; however, it is still unclear how everyday clinical practice has changed in response to this evolving scenario. The aim of this study is to describe general practitioners' (GPs) beliefs and attitudes toward the management of ED. Each GP was asked to recruit consecutive men aged >or=18 years and sexually active, with already known erectile problems or with newly diagnosed ED. A written questionnaire was used to investigate GPs' sociodemographic characteristics and their beliefs toward the management of ED. Overall, 127 GPs (53.4%) returned the questionnaire and 124 enrolled patients for the study. Only 9.5% of the GPs reported routinely inquiring about ED of patients >40 years of age, whereas 45.7% did it only when the patient raised the problem. GPs' gender and age were associated with their beliefs about ED treatment and referral to specialist care. Overall, 932 patients were enrolled, of whom 38% had newly diagnosed ED. The problem came to light for initiative of patient in 80% of cases, and 84.8% of men were prescribed a treatment. Patients who on their own initiative discussed of their condition had an almost 3-fold increased probability to be treated than those whose GP began the discussion about ED (odds ratio [OR] = 2.6, confidence interval [CI] 95% 1.5-4.5). Patients followed by female physicians were significantly more likely to be referred to a specialist than those followed by male physicians (OR = 3.3, CI 95% 1.4-5.0). The management of ED has become an integral component of clinical practice in primary care. Nevertheless, barriers in addressing sexual issues still persist. Appropriate training is needed for a proactive approach to ED screening and management in men over 40s.

ORIGINAL RESEARCH—EJACULATORY DISORDERS: Screening for Erectile Dysfunction in Men with Lifelong Premature Ejaculation—Is the Sexual Health Inventory for Men (SHIM) Reliable?

ABSTRACT Introduction Some men with premature ejaculation (PE) and normal erectile function record contradictory response/s to The Sexual Health Inventory for Men (SHIM) and may be incorrectly categorized as suffering from erectile dysfunction (ED). Aims The aim of this study was to evaluate the frequency of false positive SHIM diagnosis of ED in men with lifelong PE. Main Outcome Measures SHIM, stopwatch intravaginal ejaculation latency time (IELT). Methods A prospective observational study of men with normal erectile function and lifelong PE, diagnosed using the ISSM definition of lifelong PE, was conducted. The SHIM was self-administered at Visit 1. Mean per subject stopwatch IELT was determined from four subsequent intercourse attempts. Results Seventy-eight subjects with a mean age of 33.2 ± 8.3 years and a geometric mean IELT of 15.9 ± 2.3 seconds were enrolled. The mean SHIM score for all subjects was 20.4 ± 6.0. Fifty-two subjects (66.7%) have SHIM scores of >21 (mean 24.3 ± 1.1), consistent with normal erectile function, and a geometric mean IELT of 18.3 ± 2.2 seconds. Twenty-six subjects (33.3%) had SHIM scores <22 (mean 12.7 ± 3.7), consistent with a false positive diagnosis of ED, and a geometric mean IELT of 10.5 ± 2.3 seconds. The incidence of false positive SHIM diagnosis of ED (SHIM < 22) was inversely related to the IELT. Although the geometric mean IELT for subjects with SHIM scores <22 was significantly less than that of all subjects and subjects with SHIM scores >21, there were no significant differences between the geometric mean IELT or the IELT distribution of all subjects vs. the normal erectile function IELT (SHIM > 21) cohort. Conclusion This study demonstrates a 33.3% false positive SHIM diagnosis of ED in men with PE. This is likely to limit subject recruitment in clinical trials by exclusion of subjects with low-range IELTs but is unlikely to result in significantly different baseline IELTs or IELT distributions.

Diagnosis and management of erectile dysfunction in the primary care setting

Recent advances in the management of erectile dysfunction (ED) involve the use of oral phosphodiesterase type-5 (PDE-5) inhibitor therapies which have transformed the perception of ED for both the patient and the healthcare provider. Recent treatment guidelines, including the American Urological Association (AUA) 2005 guidelines, promote a goal-oriented approach to therapy and emphasise that PDE-5 therapy should be offered to patients with ED as a first-line treatment option, unless contraindicated. Evidence-based studies have identified an association between ED and the presence of risk factors for cardiovascular and other vascular diseases, implicating ED as a marker for other vascular conditions. Therefore, the importance of screening and diagnosis in the primary care setting is paramount in the diagnosis and management of ED-associated comorbidities. This review provides an update on ED screening and management focusing on the use of PDE-5 inhibitor therapy in the primary care setting and also discusses clinical efficacy parameters with regard to recent results from clinical trials.

Effect of Treating Erectile Dysfunction on Management of Systolic Hypertension

Erectile dysfunction (ED) is a prevalent condition and a predictor of future cardiovascular events. Screening and treatment of ED may improve management of cardiovascular risk factors. We evaluated the potential beneficial effect of newly treating ED on the management of hypertension in men in the New England Veteran Affairs Healthcare System. We conducted a retrospective cohort study using medical record data to identify patients diagnosed with and treated at any time for hypertension who received a prescription for a phosphodiesterase type 5 inhibitor (PDE5i) before February 1, 2003. Fifty percent of 6,768 men (mean +/- SD 61.6 +/- 9.9 years of age) had a systolic blood pressure (BP) > or =140 mm Hg before PDE5i administration. Overall, there was a decrease in systolic BP by 1.43 mm Hg (95% confidence interval -1.69 to -1.18) after initiation of PDE5i. The decrease in systolic BP was most pronounced in men with a systolic BP > or =160 mm Hg at baseline (-17.8 mm Hg, 95% confidence interval -18.8 to -16.8). After initiating therapy with PDE5i, patients were more likely to start an antihypertensive medication (17.3%) versus stop therapy (2.3%) and add additional antihypertensive medication to their existing therapy (42.2%) versus decrease the number of medications (17.3%). Surveillance also increased with total number of systolic BP measurements increasing by 42%. In conclusion, men with high systolic BP who initiated ED therapy had improvements in systolic BP control that may be related to clinically relevant behaviors, such as more aggressive monitoring and treatment with antihypertensive medications.

Prevalence and Risk Factors for Erectile Dysfunction in the US

Purpose To assess the prevalence of erectile dysfunction and to quantify associations between putative risk factors and erectile dysfunction in the US adult male population. Methods Cross-sectional analysis of data from 2126 adult male participants in the 2001-2002 National Health and Nutrition Examination Survey (NHANES). Erectile dysfunction assessed by a single question during a self-paced, computer-assisted self-interview. These data are nationally representative of the noninstitutionalized adult male population in the US. Results The overall prevalence of erectile dysfunction in men aged ≥20 years was 18.4% (95% confidence interval [CI], 16.2-20.7), suggesting that erectile dysfunction affects 18 million men (95% CI, 16-20) in the US. The prevalence of erectile dysfunction was highly positively related to age but was also particularly high among men with one or more cardiovascular risk factors, men with hypertension, and men with a history of cardiovascular disease, even after age adjustment. Among men with diabetes, the crude prevalence of erectile dysfunction was 51.3% (95% CI, 41.9-60.7). In multivariable analyses, erectile dysfunction was significantly and independently associated with diabetes, lower attained education, and lack of physical activity. Conclusions The high prevalence of erectile dysfunction among men with diabetes and hypertension suggests that screening for erectile dysfunction in these patients may be warranted. Physical activity and other measures for the prevention of cardiovascular disease and diabetes may prevent decrease in erectile function.

Development and Validation of a Risk Score for Somatic Erectile Dysfunction: Combined Results from Three Cross-Sectional Surveys

Objectives: Some men with erectile dysfunction (ED) have difficulties discussing their condition with their physicians. Existing screening and diagnostic tools for ED often require the administration of personal questions regarding the condition. We present a simple risk score to estimate the individual likelihood of somatic ED, based on age and existing health conditions. Methods: Data from the Cologne Male Survey ( n = 4396) were used to develop a multivariable logistic regression model for the individual ED likelihood. The regression equation was both internally and externally validated using data from a national study (Berlin study) and a multinational cross-sectional study (MALES study). Results: A final regression equation including age, pelvic surgery, diabetes mellitus, arterial circulatory disorder, heart disease, smoking, and hypertension reached an area under the receiver operating characteristic curve of 0.84 (0.5 means random and 1.0 perfect discrimination). Internal validation did not indicate any relevant overfit and the external validation results (national data: AUC = 0.75; multinational data: AUC = 0.67) are similar to those of other popular risk scores. Conclusions: The validated ED risk score developed from the regression equation can be used as a screening tool to identify patients who are at a high risk of somatic ED. This tool can facilitate entering into discussions between physicians and patients regarding erectile function.

Screening for erectile dysfunction as part of periodic examination programs--concept and implementation.

Erectile dysfunction (ED) can be an early and first sign of an underlying systemic disease. A screening program is offered by the Israeli Defense Force for career servicemen at the staff periodic examination center (SPEC), the aim of which was early detection of morbidity. We introduced the Sexual Human Inventory for Males (SHIM) questionnaire, in order to detect examinees with ED, and offer them suitable treatment options. The purpose of this study is to introduce the concept of an ED questionnaire as part of a screening program, and to describe the first months of its implementation. A computerized questionnaire is used to collect the medical history. The SHIM questionnaire was incorporated into the medical questionnaire. Relevant data including compliance to reply, SHIM scores, age and accompanying diseases of patients were collected from the computerized database of SPEC. A total of 2182 patients reported to SPEC from 1/5/01 to 1/11/01, 1980 of whom were males. Of the males, 881 (44.5%) chose to fill the SHIM questionnaire (mean age 34.5 +/- 6.7 y), and 244 of them (27.7%) had a score of 21 or less (20.7% had 17-21, 5.7% 11-16, 1.4% 0-10). The prevalence of ED and its severity increases with age. An inverted linear correlation was found between age and SHIM score (r = -0.22, P<0.0001). Prevalence of hypertension and diabetes mellitus is higher in patients with SHIM score < or =16 compared to those with a score > or =22. Only 15% of men with ED refer themselves for medical help. The concept of adding an ED questionnaire to a screening program may encourage more men to seek treatment, not only for their ED, but also for the underlying disease. The platform of a periodic examination offers maximum privacy to the examinees, resulting in better cooperation.

Quality control in the screening of erectile dysfunction—results of a survey

Objectives. To evaluate the screening patterns of primary care physicians with regard to erectile dysfunction (ED). Methods. A prospective study was performed using an institutional review board-approved Sexual Health Inventory for Men questionnaire of male patients presenting to a university-based urology clinic. The data were compiled and analyzed with descriptive statistics using Statistical Package for Social Sciences, version 10.0, software. Results. Of 140 patients, 102 completed and returned the survey. Of these patients, 93% were white. Twenty-five percent were between the ages of 40 and 50 years, 20% were between the ages of 51 and 60 years, and 24% were between the ages of 60 and 70 years. The average number of risk factors for ED identified in the patient population was 2.1. Fifty-six percent of patients had a Sexual Health Inventory for Men score of 21 or less, indicative of an element of ED. Eighty-three percent had primary care physicians; 23% of patients with a primary care physician were screened for ED. Of those screened, 58% of patients initiated the discussion with their physician. Conclusions. Screening for ED, using the Sexual Health Inventory for Men instrument, should be performed on patients with any identifiable risk factor. Screening is appropriate because effective treatment of ED is available and because ED can be associated with occult cardiac disease.

Sexuality and erectile dysfunction: Results of a national survey

BACKGROUND: Research into the sexual behaviour of men and women who experience sexual problems is lacking. In spite of much recent progress in the field of pharmacotherapeutics for erectile dysfunction (ED), there is little information on issues such as the importance of talking about sex between partners, and people’s satisfaction with their sex lives. There is also a perceived lack of communication between men, their partners and their physicians about erectile dysfunction. To obtain quantitative information, a large survey of the adult Canadian population was undertaken. METHODS: Telephone interviews were conducted with adults across Canada. Respondents were drawn at random using predictive dialer technology. Final data were weighted to represent the adult Canadian population according to the latest census data. The margin of error was ±1.78% 19 times out of 20. RESULTS: Most of the people who were surveyed were involved in a relationship at the time and most were able to have open discussions about sex with their partners. According to the respondents, the most difficult issue to discuss was sexual performance. The prevalence of ED was 27% of sexually active men, with onethird feeling that it impacted their quality of life. Only 25% of men with ED consulted a medical professional. Following those consultations, many respondents reported improved erectile function, but of those who had not consulted a medical professional, few intended to do so in the near future. However, most men with ED reported that they would be willing to discuss the problem if their physicians raised the issue, and agreed that physicians are responsible for screening for ED. While men reported that they would be open to routine screening, most had not been screened for ED. CONCLUSIONS: This survey provided health care professionals with several key messages: health care professionals should ask their patients about their sexual health; they should take a sexual history as a regular part of the annual check-up; they should encourage their patients to discuss their sexual health with their partners; and they should understand that the patient’s quality of life can be improved when ED is dealt with in a positive, empathetic manner.

Intracavernous Injection During Diagnostic Screening for Erectile Dysfunction; Five-year Experience with over 600 Patients

Psychophysiological diagnostic screening (PDS) was carried out on just over 1000 consecutive patients with erectile dysfunction (ED) during 1995 through 1999. Roughly one-third did not require an intracavernous injection (ICI) because of optimal penile response during visual and tactile penile sexual stimulation. The present article deals with those other patients ( n = 609) who required an ICI and completed a 24-hour-postinvestigation questionnaire (PIQ). The two ICI preparations used, prostaglandin and papaverine + fentolamine, were virtually equally effective in the doses applied, with very low and similar percentages of unwanted side effects, for example, prolonged erection. Somatic ED patients displayed the lowest penile responses to ICI, whereas psychogenic ED patients had the highest penile responses. ED patients who also suffered from premature ejaculation (PE) ejaculated significantly more readily during PDS than those without PE. An ICI following an ejaculation/ orgasm could lead to an erection presumably sufficient for intromission, which indicates ICI as a therapeutic option for rapid ejaculators. Our elaborate and lengthy PDS procedure, particularly the use of penile vibration as an addition to the visual sexual stimulation, obviates the diagnostic use of the PIQ.

Screening for erectile dysfunction: rationale.

A number of epidemiologic and clinical studies that have examined the relationship between erectile dysfunction, depression and cardiovascular disease are reviewed. Hypothetical mechanisms that can explain the correlations observed among these phenomena are described and a mutually reinforcing predictive model is proposed. International Journal of Impotence Research (2000) 12, Suppl 4, S147-S151.