Self-reported Erectile Dysfunction Research Articles

Prevalence and Correlates of Self-Reported Erectile Dysfunction among Adult Male Patients Receiving Cardiovascular Care in Southern Nigeria

Abstract Background: The global incidence of erectile dysfunction (ED) is on the rise, with an estimated 152 million men currently affected. Cardiovascular risk factors are strongly linked to the occurrence of ED, particularly in men with cardiovascular disease (CVD). In countries like Nigeria, where it is not typically viewed as life-threatening, ED often receives less attention. Consequently, there is limited data on selfreported ED among patients seeking cardiovascular care in cardiac clinics. Therefore, this study aims to determine the prevalence of self-reported ED among adult patients with CVD visiting a cardiac center. Materials and Method: A retrospective hospital-based study of self-reported ED patients carried out in a cardiac center among males (31-82 years) in Port Harcourt, Southern Nigeria, over a one-year period (October 2022 to January 2024). Participants’ demographic data and medical history were retrieved and analyzed. Results: The study had a total of 23 male subjects. Majority of the participants were between 50-69 years old (47.8%), 65.2% took alcohol and 21.7% smokes cigarette. 82.6% had a history of hypertension and (73.9%) were on antihypertensive, (34.8%) had diabetes mellitus, (17.4%) were on antidiabetic while (60.9%) were on other forms of medication. Overweight and obesity account for 34.8% and 52.2% of the subjects respectively. Beta-blocker (23.5%) was the frequently used medication and angiotensinconverting enzyme (ACE) inhibitors was the least accounting for (5.9%). Conclusions: The increasing incidence of ED among patients with CVD risk factors and an aging population suggest that patients should be screened. ED may become a significant public health problem and closer attention needs to be paid to control these patients to reduce further complications. Keyword: Erectile dysfunction, cardiovascular risk factor, cardiac Centre, self-reported, Good Heart medical consultants’ Hospital.

Correlation between visceral fat metabolism score and erectile dysfunction: a cross-sectional study from NHANES 2001-2004.

The factors associated with erectile dysfunction (ED) are diverse, and obesity is a significant component. Metabolic Score for Visceral Fat (METS-VF) can assess obesity more accurately than body mass index (BMI). However, the association between METS-VF and ED remains unclear. This study aimed to investigate the association between the METS-VF and ED using National Health and Nutrition Examination Survey (NHANES) 2001-2004 data. Data were sourced from NHANES 2001-2004. The relationship between METS-VF and ED was analyzed using multivariate logistic regression, followed by subgroup analyses to identify sensitive populations. Nonlinear correlation was evaluated through smoothed curve fitting, and a threshold effect analysis validated the findings. Comparative logistic regression of the Receiver Operating Characteristic (ROC) curve assessed the diagnostic capability of METS-VF against the classical obesity index for ED. The study enrolled 3625 participants, of whom 961 self-reported ED history and 360 reported severe ED. After adjusting for confounders, METS-VF exhibited a positive association with asthma prevalence (OR= 3.47, 95% CI: 2.83, 14.24). Stratification based on median METS-VF revealed higher ED prevalence in participants with elevated METS-VF (OR= 2.81,95% CI:2.32, 3.41). Nonlinear correlation was observed, with a significant association between METS-VF and ED when METS-VF exceeded 6.63. Subgroup analysis highlighted a stronger correlation in participants aged 50-85 years, Caucasians, hypertensive individuals, diabetics, and those with coronary heart disease. Sensitivity analysis using severe ED as the outcome reaffirmed the nonlinear positive association with METS-VF (OR=3.86, 95% CI:2.80,5.33), particularly when METS-VF surpassed 6.68. Elevated METS-VF was nonlinearly correlated with increased ED incidence. Individuals with METS-VF above 6.63 should be vigilant about heightened ED risk. Special attention should be given to participants aged 50-85 years, Caucasians, hypertensive individuals, diabetics, and those with coronary heart disease.

Prevalence of Erectile Dysfunction and its Associated Factors among Men in Government Health Clinics in Kuantan, Pahang

INTRODUCTION: Erectile dysfunction (ED) is a significant issue that should not be ignored in the clinical setting and can negatively affect the quality of life of patients and their partners. This study aims to determine the prevalence of ED and its associated factors among men who visited 12 government health clinics in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: Between July and October 2021, 300 males aged 18 to 60 participated in this cross-sectional study at 12 government health clinics in Kuantan. Information on demographic data, medical history, and lifestyle of the participants was obtained through a self-administered questionnaire that included a validated Malay version of the 21 item Depression Anxiety Stress Scale (DASS 21) and the International Index of Erectile Function (IIEF-5). RESULTS: The overall prevalence of self-reported ED was 69.3%. In terms of severity, 45.7% had mild, 20.7% mild-to-moderate, 2.3% moderate, and 1% severe ED. Multivariate analysis showed that ED associated with diabetes (OR 2.97, 95% CI 1.13–7.79); anxiety (OR 2.85, 95% CI 1.06 – 7.67) and household income (OR 0.41, 95% CI 0.18–0.95). CONCLUSION: ED was high in our study population. Diabetes mellitus, anxiety and household income were significantly associated with ED.

(441) Quantifying Men with Erectile Dysfunction Potential Candidates for Penile Prosthesis Implantation in the US

Abstract Introduction While penile prosthesis implantation (PPI) is a recommended treatment option per the American Urological Association for men with erectile dysfunction (ED), there are a limited number of urologists performing PPI procedures in the US. Objective This study quantified the number of US men with ED and projected the number of potential candidates for PPI in 2022. Methods An excel-based disease-impact model was constructed using a top-down estimation approach based on two age groups for ED: 18-64 and ≥65 years old. The starting US male population was extracted from the 2022 US Census after the removal of age-specific mortality rates obtained from the National Vital Statistics Reports. Only men who subscribed to public or private health insurance were included in the model using insurance status data from the US Census. ED prevalence rates were obtained from administrative claims data analyses (IBM® MarketScan® Commercial Database [18-64 years] and 5% Medicare Standard Analytical Files [≥65 years]) using relevant International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes to calculate a base-case estimate of men with ED. To quantify the number of PPI candidates, the rate of men with ED but without ED treatment was obtained from the claims data and combined with the proportion of men with moderate-to-severe ED obtained from published research. The ED prevalence obtained from the administrative claims data analyses reflects a documented diagnosis of ED, which may underestimate the actual US prevalence of ED. Therefore, scenario analyses were conducted using patient-reported ED prevalence data obtained from a literature search of Medline. Results Using the ED prevalence obtained from the administrative claims data analyses, an estimated 8.3% of insured men (8,882,548 aged 18-64 and 1,419,992 aged ≥65) had a diagnosis of ED from 124,318,519 eligible US men aged ≥18 in 2022. The base-case estimate using claims data for the untreated ED rate and published literature for the proportion with moderate-to-severe ED showed 17.1% of men with an ED diagnosis claim could benefit from PPI (1,759,248 men aged ≥18). The literature review for the scenario analyses identified 11 publications from 2000 to 2020 with patient-reported ED prevalence. ED prevalence was assessed using different methods: International Index of Erectile Function (IIEF; 3 publications, 27.3%), Massachusetts Male Aging Study (MMAS)-derived questionnaire (3 publications, 27.3%), and other patient self-reported questionnaires (5 publications, 45.5%). Patient self-reported ED prevalence across all ages ranged from 5.1% to 70.2%. Applying the patient self-reported ED prevalence range to the scenario analyses, it was found that as many as 13,436,363 men in the US with ED could benefit from PPI. Conclusions From this disease-impact model, the estimated number of US men with ED is 124,318,519 as of 2022. Between 1.7 and 13.4 million of these men could potentially benefit from PPI. Ensuring sufficient penile prosthesis implanters could mitigate the potential physical, emotional, and social burden of untreated ED. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific Clarification Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific

Quantifying the number of US men with erectile dysfunction who are potential candidates for penile prosthesis implantation.

Penile prosthesis implantation (PPI) is a treatment option recommended in clinical guidelines for erectile dysfunction (ED). However, a limited number of urologists perform PPI procedures in the United States. To quantify the number of insured men with ED in the United States and project the number of potential candidates for PPI in 2022. An Excel-based disease impact model was constructed using a top-down estimation approach. The starting US male population consisted of adult men from 2022 US Census data after exclusion of age-specific mortality rates from the National Vital Statistics Reports. Men with health insurance were included in the model based on insurance status data from the US Census database. ED prevalence and ED treatment rates were obtained from administrative claims data analyses-the Merative MarketScan Commercial Database (18-64years) and the 5% Medicare Standard Analytical Files (≥65years)-and literature-based estimates of patient-reported ED prevalence. The number of men with ED in the United States and the number of potential candidates for PPI were estimated. By utilizing ED prevalence based on administrative claims, an estimated 8.3% of insured men (10,302,540 estimated men [8,882,548 aged 18-64 years and 1,419,992 aged ≥65 years]) had a diagnosis of ED and sought ED care, out of 124,318,519 eligible US men aged ≥18 years in 2022. An estimated 17.1% of men with an ED diagnosis claim could benefit from PPI in 2022 (1,759,248 men aged ≥18 years). Patient self-reported ED prevalence across all ages ranged from 5.1% to 70.2%. Scenario analyses applying the patient self-reported ED prevalence range revealed the number of men in the United States who could benefit from PPI could have been higher than 1.7 million if their ED symptoms were diagnosed by health care providers. Most men with ED in the United States are undertreated, and many could benefit from PPI. This analysis is a US population-level estimation. However, given this study utilized a variety of assumptions, the results may vary if different model assumptions are applied. This disease impact model estimated that approximately 10.3 million men were diagnosed with ED by their health care providers and sought ED care in the United States in 2022. Of those, 1.7 million men could be PPI candidates and benefit from the treatment option.

Effects of Erectile Dysfunction Drugs Use on T-Cells and Immune Markers on Men Who Have Sex with Men

Objective Examine prospective relationships between erectile dysfunction (ED) drugs and CD4 and CD8 T-cells, and immune markers among men who have sex with men (MSM). Methods Data from Multicenter AIDS Cohort Study, an observational prospective cohort study, with semiannual follow-ups conducted in four U.S. centers from 1998 onwards was used. Marginal structural models using g-computation were fitted to estimate the mean differences for the effects of self-reported ED drug use on CD4 and CD8 T-cell outcomes and immune biomarkers. Results Total of 1,391 men with HIV (MWH) and 307 men without HIV (MWOH) was included. Baseline mean CD4 cell count among MWH and MWOH was 499.9 and 966.7 cells/μL, respectively. At baseline, 41.8% of MWH were virally suppressed. ED drug users reported a mean of 44.4 months of exposure to ED drugs. ED drug use was associated with increased CD4 cell outcomes among MWH but not MWOH. Mean differences in CD4 cell counts after 1 year of ED drug use was 57.6 cells/μL and increased to 117.7 after 10 years among MWH. CD8 counts were higher in ED drug users among MWH over 10 years than non-users; no consistent differences were found among MWOH. ED drug use appeared to reduce immune marker levels, such as IL-6 and increase markers, such as IL-10. We observed similar effects of ED drug use on biomarker levels among MWOH. Conclusion Long-term use of ED drugs do not adversely affect immune function among MWH or MWOH. Future studies on the relationships between different types of ED drugs and effects on T-cell subtypes are warranted.

Associations between exposure to different heavy metals and self-reported erectile dysfunction: a population-based study using data from the 2001-2004 National Health and Nutrition Examination Survey.

Heavy metals are ubiquitous and nonbiodegradable pollutants that are widely distributed in the environment. Heavy metal exposure can damage various biological tissues and cause several diseases. This study aimed to investigate the association between blood and urinary cadmium, lead, and mercury levels and erectile dysfunction (ED) based on data from the 2001-2004 National Health and Nutrition Examination Survey. In total, 3681 participants were included in the analysis. Results showed that participants with ED had high blood cadmium, mercury, creatinine, urinary lead, cadmium levels, low blood lead, serum cotinine, and urinary mercury levels. Multivariate logistic regression analysis showed that only blood cadmium level was an independent risk factor of ED (tertile [T]2 vs T1: odds ratio = 1.495, 95% confidence interval: 1.181-1.892, p = 0.001; T3 vs T1: odds ratio = 2.089, 95% confidence interval: 1.554-2.809, p < 0.001). The dose-response curve showed a positive nonlinear association between blood cadmium and lead levels and ED and a negative nonlinear association between blood and urinary mercury levels and ED after propensity score matching. In conclusion, heavy metal exposure is closely correlated with the development of ED, and a high blood cadmium level is an independent risk factor of ED.

Intracavernous injection of stem cell-derived bioactive molecules for erectile dysfunction—a pilot phase non-randomized controlled trial

Background and objective: Experimental and few clinical studies have indicated great potential of stem cell treatments as both a causal and symptomatic approach for the treatment of male erectile dysfunction (ED). We investigated the effect of a one-time injection of stem-cell derived bioactive molecules in patients with self-reported ED. Materials and methods: Twenty self-referred male patients with at least one-year history of ED received a one-time intra-penile injection of acellular stem cell-derived bioactive molecules. ED was evaluated by the International Index of Erectile Function questionnaire (IIEF-5), and quality of life was assessed by the Short-Form-36 questionnaire, (SF-36) at baseline and at 6 months. Six male patients with ED, who received a similar injection using saline served as a historic control. Primary outcome was erectile function as measured by IIEF-5 scores. Secondary outcomes were quality of life, assessed by SF-36 questionnaire. Results: IIEF-5 scores improved from 12.9 ± 4.47 at baseline to 18 ± 3.37 at follow-up (p &lt; 0.05). No significant difference of IIEF-5 scores were observed in the historic controls during the observation period (11 ± 2.53 at baseline vs 10.67 ± 3.5 at follow-up; p &gt; 0.05). Patients, who received stem cell injections, demonstrated significantly enhanced IIEF-5 scores compared to the historic control (p &lt; 0.05). Quality of life scores were significantly improved (role limitations due to physical health issues 56.25 ± 42.82 at baseline vs 68.75 ± 40.45 at follow-up, p &lt; 0.05, energy 51.57 ± 19.33 at baseline vs 57.75 ± 12.3 at follow-up, p &lt; 0.05, emotional wellbeing 56.32 ± 16.28 at baseline vs 68.1 ± 11.73 at follow-up, p &lt; 0.05, and social functioning 67.5 ± 23.79 at baseline vs 76.25 ± 18.98 at follow-up, p &lt; 0.05). Conclusions: A one-time intracavernous acellular stem cell-derived bioactive molecule injection improves IIEF-5 scores and quality of life in men with ED in this small pilot phase study (ClinicalTrials.gov Identifier: NCT04684602).

This Month in Adult Urology

This Month in Adult Urology

The Validity of using a Single-Question Self-Report of Erectile Dysfunction as a Screening Tool among Men with Type 2 Diabetes Mellitus

Background and objectiveThis study aimed to determine the validity of using a single-question self-report of erectile dysfunction (ED) as a screening tool among Saudi men with type 2 diabetes mellitus (T2DM). Materials and methodsA cross-sectional study was conducted using a single-question self-report questionnaire to determine the association between the risk of ED and poor glycemic control among men with T2DM. The study was conducted in a hospital-based diabetes clinic in Riyadh, Saudi Arabia. Married adults (aged >18 years) suffering from T2DM for at least 1 year were included in the study. All statistical analy-ses were performed using SAS version 9.2 and R software (Foundation for Statistical Computing, Vienna, Austria). ResultsWith 86% response rate, 293 participants were included in this study. Over half (53.9%) of the partic-ipants were below 60 years of age. More than half (55.3%) were suffering from uncontrolled diabetes (i.e., HbA1c > 7%). There was significant correlation between the International Index of Erectile Function (IIEF) and self-reported question in terms of duration of T2DM (p < 0.001), type of treatment (p = 0.004), income of the participants (p = 0.005), age (p < 0.001), education level (p = 0.032), and occupation (p < 0.001). However, there was no significant correlation between IIEF and self-reported question in terms of body mass index (p = 743) and smoking. Regarding overall diagnostic accuracy of IIEF score to predict self-reported ED, receiver operating characteristic curve showed area under curve as 89.4%, which is sta-tistically significant. ConclusionSingle-question self-report of ED is a valid and reliable tool to screen diabetic patients suffering from sexual problems. Such tool may help to identify ED in diabetic patients and warrant early management.

Association of Erectile Dysfunction with Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA)

PurposeErectile dysfunction has been associated with atrial fibrillation in cross-sectional studies, but the association of erectile dysfunction with incident atrial fibrillation is less well established. This study aimed to determine whether erectile dysfunction is independently associated with incident atrial fibrillation after adjusting for conventional risk factors. MethodsWe studied 1760 male participants (mean age 68 ± 9 years) from the Multi-Ethnic Study of Atherosclerosis (MESA), who completed self-reported erectile dysfunction assessment at MESA exam 5 (2010-2012). Cumulative incidence of atrial fibrillation was estimated by Kaplan-Meier analysis. Cox proportional hazards regression was used to calculate the unadjusted and adjusted hazard ratios (HR) using 3 models in which variables were added in a stepwise manner. In model 3, HR was adjusted for age, race and ethnicity, education, smoking status, alcohol use, systolic blood pressure, body mass index, diabetes, anti-hypertensive medication use, lipid-lowering medication use, total cholesterol, and estimated glomerular filtration rate. ResultsDuring the median follow-up of 3.8 (interquartile range, 3.5-4.2) years, 94 cases of incident atrial fibrillation were observed. There was a significant difference between males with and without erectile dysfunction for cumulative incident atrial fibrillation rates at 4 years (9.6 vs 2.9%, P < .01). In the fully adjusted model, erectile dysfunction remained associated with incident atrial fibrillation (model 3; HR, 1.66; 95% confidence interval 1.01-2.72, P = .044). ConclusionsAmong older male participants in this prospective study, we found that self-reported erectile dysfunction was associated with incident atrial fibrillation.

Is Pornography Use Related to Erectile Functioning? Results From Cross-Sectional and Latent Growth Curve Analyses

IntroductionDespite evidence to the contrary, a number of advocacy and self-help groups persist in claiming that internet pornography use is driving an epidemic of erectile dysfunction (ED). AimThe present work sought to explore whether mere pornography use itself and self-reported problematic use of pornography are related to ED, both cross-sectionally and longitudinally. MethodsA series of 3 samples of sexually active men who also used pornography were collected: a cross-sectional sample of undergraduate men in the United States (n = 147), an online sample of men derived from a larger sample that was matched to U.S. nationally representative norms (n = 297), and a 1-year, 4-wave longitudinal sample of adult men derived from an online convenience sample (Mechanical Turk: time 1, n = 433; time 2, n = 223; time 3, n = 202; time 4, n = 196). Pearson correlations and cross-sectional structural equation models were conducted in each sample. Latent growth curve analyses were conducted in the longitudinal sample. Main Outcome MeasureThe primary outcomes of interest were cross-sectional and longitudinal reports of erectile functioning as measured by the International Index of Erectile Functioning 5. ResultsAcross all 3 samples, there was evidence of a positive, cross-sectional association between self-reported problematic use and ED, but no consistent association between mere use itself and ED. In our longitudinal sample, there were correlations among baseline pornography use, baseline self-reported problematic use, and prospective ED at times 2–4; however, latent growth curve analyses demonstrated no significant relationships between any pornography-related variables and trajectories of ED. Clinical ImplicationsThese results suggest that among non-treatment-seeking pornography users, self-reported problematic use likely is associated with concurrent reports of ED, but that the links between these variables are not directional or causal in nature. Strength & LimitationsThis work is the first work to systematically examine the links between self-reported problematic use of pornography and ED, and it did so in a variety of samples, using both cross-sectional and longitudinal methods. Even so, the work relied exclusively on self-report methods, and did not control for medical covariates that may be related to the experience of ED. ConclusionIn conjunction with prior literature, we conclude that there is little or no evidence of an association between mere pornography use and ED, consistent evidence of an association between self-reported problematic use and ED cross-sectionally, and no evidence of causal links between any pornography variables and ED.Grubbs JB, Gola M. Is Pornography Use Related to Erectile Functioning? Results From Cross-Sectional and Latent Growth Curve Analyses. J Sex Med 2019;16:111–125.

Prevalence and predictors of erectile dysfunction in adult male outpatient clinic attendees in Johor, Malaysia.

Erectile dysfunction (ED) is a serious global burden that affects men as well as their partners. This study aimed to determine the prevalence and predictors of ED among male outpatient clinic attendees in Johor, Malaysia. We conducted a cross-sectional study of Malaysian men aged ≥ 18 years attending two major outpatient clinics in Johor Bahru and Segamat in Johor, Malaysia, between 1 January 2016 and 31 March 2016. Subjects were chosen via simple random sampling and 400 patients were recruited. The study instrument was a survey form that consisted of three sections: sociodemographic and comorbid profile, validated English and Malay versions of the 15-item International Index of Erectile Function, and the 21-item Depression Anxiety Stress Scale. The overall prevalence of self-reported ED was 81.5%. The prevalence of ED according to severity was as follows: mild (17.0%), mild to moderate (23.8%), moderate (11.3%) and severe (29.5%). Multivariate analysis showed that ED was associated with increasing age (odds ratio [OR] 4.023, 95% confidence interval [CI] 1.633-9.913), Indian as compared to Malay ethnicity (OR 3.252, 95% CI 1.280-8.262), secondary as compared to tertiary education (OR 2.171, 95% CI 1.203-3.919), single as compared to married status (OR 6.119, 95% CI 2.542-14.734) and stress (OR 4.259, 95% CI 1.793-10.114). ED has significant prevalence and severity among adult male outpatient clinic attendees in Johor. Increasing age, Indian ethnicity, lower educational level, singlehood and stress were significant predictors of ED.

Changes in the Prevalence and Risk Factors of Erectile Dysfunction during a Decade: The Korean Internet Sexuality Survey (KISS), a 10-Year-Interval Web-Based Survey.

PurposeAlthough the prevalence of erectile dysfunction (ED) can be affected by social changes, this association has not been well evaluated. We aimed to evaluate the prevalence and risk factors of ED through a 10-year-interval web-based survey using the previous database of same group of panels, with same methodology.Materials and MethodsWe sent e-mails and surveyed the panels registered in the Internet survey agency.ResultsIn total, 900 participants were recruited in 2016. The age-adjusted overall prevalences of self-reported ED (self-ED) and International Index of Erectile Function-5-assessed ED (IIEF-5-ED; score ≤21) in the 2016 study were 3.2% and 44.8%, respectively, which were lower than the prevalences of 8.1% (p=0.036) and 51.4% (p=0.323), respectively, in the 2006 study. The risk factors of IIEF-5-ED in their 20s and 30s in 2016 were psycho-social factors such as depression, low frequency of conversation about sex with sexual partner. The risk factors of IIEF-5-ED in their 40s to 60s in 2016 were organic factors, such as hypertension, diabetes mellitus, smoking, alcohol use, and self-reported premature ejaculation.ConclusionsAlthough the age-adjusted overall prevalence of self-ED has decreased during a decade, there was no difference in the age-adjusted overall prevalence of IIEF-5-ED. Psycho-social support may be important for young men with ED and overall healthcare can be helpful for elderly men with ED.

714 Increased prevalence of premature ejaculation on a 10-year interval web-based survey

We performed a 10-year interval survey of prevalence and risk factors of premature ejaculation (PE) in Korean adult men. We sent e-mails to the panels registered in the internet survey agency, and asked to participate a questionnaires survey of the same design and same company as that in 2006. The total number of 900 participants were enrolled. The character and prevalence of PE were evaluated using questionnaires. PE was defined based on DSM-IV-TR and ISSM, respectively. The prevalence of self-PE after age-adjustment in the 2016 study was similar compared to that in the 2006 study (19.0 vs. 21.6%, p=0.273). The age-adjusted prevalence of DSM-IV-TR-PE (7.0 vs. 24.7, p<0.001) and ISSM-PE (1.8 vs. 4.0%, p=0.029) were significantly higher in 20016 compare to those in 2006, respectively. On multivariable analysis, masturbation (OR: 2.498, p<0.001) and self-reported erectile dysfunction (OR: 4.476, p<0.001) were risk factors for self PE although frequent conversation about sex with partner (OR: 0.597, p=0.017), unmarried state (OR: 0.484, p=0.005), Income ≥ $3521 (OR: 0.682, p=0.045), and constipation (OR: 0.484, p=0.026) decreased the probability of self-PE. On multivariable analysis, age (OR: 1.028, p=0.006), high BMI (OR: 1.075, p=0.005), unmarried state (OR: 1.648, p=0.037), and experience of rape or sexual harassment (OR: 1.496, p=0.047) were determined as the risk factors for DSM-IV-TR PE. On multivariable analysis, the history of sexual transmitted disease (OR: 17.97, p=0.035) was the only risk factor for ISSM-PE.

664 Prevalence of self-reported erectile dysfunction at first medical assessment in men with Peyronie’s disease – Preliminary findings of a real-life cross-sectional study

664 Prevalence of self-reported erectile dysfunction at first medical assessment in men with Peyronie’s disease – Preliminary findings of a real-life cross-sectional study

Impact of anabolic androgenic steroids on sexual function.

BackgroundTo describe the impact of supra-physiologic anabolic-androgenic steroid (AAS) use, including agent, dosage, and duration of therapy, on sexual function.MethodsWe reviewed data from an online survey of AAS users to evaluate their sexual function on and off AAS. The online survey consisted of questions addressing demographics, anabolic steroid use and patterns, ancillary medications, testosterone (T)-related symptoms while on and off of therapy, as well as sexual function which was assessed using the 5-item, International Index of Erectile Function (IIEF-5).ResultsA total of 321 men responded to the survey, of which 90 failed to meet inclusion criteria, for a final cohort of 231 AAS users. The majority of men were Caucasian (85%), employed (62%), and younger than 35 years (58%), while an equal mix were single (47%) or married (46%). The mean IIEF-5 was 22.5, with higher scores associated with increased T dosages (>600 mg/week), use of 17-alpha alkylated hormones and anti-estrogens, and absence of concurrent medical conditions. Lower mean IIEF scores were associated with current and pre-AAS low T symptoms, self-reported angry or violent tendencies, self-reported erectile dysfunction (ED), decreased libido, decreased energy, and depression. After controlling for age, low T symptoms and decreased energy remained significantly associated with lower IIEF scores. Among 127 men reporting de novo decreased libido when not taking AAS, several factors were significantly associated including frequency and duration of T and use of adjunctive therapies, while post-cycle therapies were protective. Men who reported any other de novo symptom (decreased energy, libido, muscle mass or depression) after discontinuing T were also more likely to report de novo ED, as well as those using >10 years or for >40 weeks per year.ConclusionsThe long-term impact of high dose AAS use on sexual function remains poorly defined. Although high T dosages appeared to be protective of erectile function during use, de novo symptoms such as decreased libido and ED occurred more frequently after discontinuing T, particularly among those using more frequently and for longer durations. Given the importance of these findings, long-term studies evaluating the impacts of discontinuing T on sexual dysfunction are indicated.

PDE-5 inhibitors should be used post radical prostatectomy as erection function rehabilitation? | Opinion: No.

The advancement and refinement in prostate cancer detection and treatment mo-dalities have contributed to a younger patient population undergoing radical prostatec-tomy (RP) (1). Although it is effective in treating prostate cancer, radical prostatectomy has also been shown to compromise erectile function (EF), and therefore the patient’s quality of life and general well being (2). Alemozaffar et al. (3) attempted to predict erectile function after prostate cancer patients undergoing RP, external radiotherapy and brachytherapy. Pretreatment sexual health related quality of life score, age, serum prostate-specific antigen level, race/ethnicity, body mass index and intended treatment details were associated with functional erections 2 years after treatment. They found that 48% of patients (n=1027) with functional erections prior to treatment reported erectile dysfunction 2 years after treatment. In the prostatectomy cohort, 60% of patients with prior functional erections reported erectile dysfunction, along with 42% and 37% of the external radiotherapy and brachytherapy cohorts, respectively. The Prostate Cancer Outcomes study revealed 60% of men experienced self-reported erectile dysfunction 18 months after radical prostatectomy, and only 28% of men reported erections firm enough for intercourse at a 5-year follow-up (4). Many urologists believe more patients would be willing to undergo surgical treatment if it were not for the possibility of developing postoperative ED (2). The discovery of the neurovascular bundle sparing technique by Dr. Patrick Walsh enabled urologists to provide hope of regaining erectile function after radical prostatectomy (5). However, despite meticulous dissection to preserve the neurovascular bundle, there is evi-dence that neuropraxia, ischemic and hypoxic nerve insults, fibrotic remodeling, and apopto-sis of cavernous smooth muscle contribute to post-surgery erectile dysfunction (6).

Abstract P017: Serum Vitamin D, Sex Hormones, and Erectile Dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Activated Vitamin D regulates testosterone (T) and estradiol (E2) synthesis. 25-hydroxyvitamin D [25(OH)D] deficiency has been associated with low T levels in men with conflicting associations described in women. Low 25(OH)D is associated with increased cardiovascular (CVD) risk and possibly with erectile dysfunction (ED) in men. We examined the association of 25(OH)D with sex hormones (SH) in men and women and with ED in men in a multi-ethnic cohort (mean age 63 yrs). Methods: 25(OH)D,T, E2, dehydroepiandrosterone (DHEA), and SH binding globulin (SHBG) levels were measured at MESA exam 1 (2000-2002), and bioavailable T calculated. Self-reported ED was recorded at exam 5 (2010-2012). Using linear regression, we evaluated the multivariable adjusted cross-sectional associations of 25(OH)D and SH separately by sex. Among men, we used logistic regression to assess the association of 25(OH)D with odds of low T&lt;10.41 nmoI/L (300 ng/dl) [9.4%] at exam 1 and with ED at exam 5. Results: After adjusting for demographic and lifestyle variables, higher 25(OH)D levels were associated with greater total T and SHBG in men and with greater E2, SHBG, and lower bioavailable T and DHEA in women [ Table ]. Compared to ≥30 ng/ml, 25(OH)D deficiency (&lt;20 ng/ml, 31% men and 32% women) was associated with increased odds of low T in men in age/race model [1.37 (1.05, 1.77)] but was attenuated after adjusting for lifestyle variables [1.19 (0.91, 1.55)]. Among 1796 men with 25(OH)D and T at exam 1, 45% were found to have ED at exam 5. Neither 25(OH)D deficiency nor low T was associated with ED. In all analyses, results were similar after further adjusting for CVD risk factors. Conclusion: Higher 25(OH)D levels were associated with higher SHBG in both men and women, greater T in men, and greater E2 and lower DHEA in women independent of adiposity and lifestyle. 25(OH)D deficiency and low T were not associated with prevalent self-reported ED assessed 10 years later. Future studies are needed to determine if treating low vitamin D can influence sex hormone levels.

Subjective effects of a combined lipid-lowering nutraceutical or ezetimibe on well-being and sexual performance in patients with perceived worsening of erectile function during statin treatment: a randomised clinical trial

Beyond clinical trial evidence, the perceived association of statin use and impotence in general practice is not infrequent and the most common associated consequence is the discontinuation of the statin treatment. To carry out a randomised clinical trial on Caucasian men refusing to continue statin therapy because of perceived worsening of erectile function in order to test the tolerability of alternative lipid-lowering strategies. This is a single-blind, randomised clinical trial carried out on 50 moderately hypercholesterolaemic subjects (mean age: 54±6 years old) who voluntarily interrupted statin treatment because of self-reported erectile dysfunction (ED) during statin treatment, randomised to treatment with ezetimibe 10 mg or a combined lipid-lowering nutraceutical containing red yeast rice and berberine (3 mg monacolins and 500 mg per dose, respectively), to be taken as one dose per evening for 12 weeks. The effects of both treatments on ED and subjective well-being was tested by administrating, before and after 12 weeks of treatment, the International Index of Erectile Function (IIEF-5) and the Satisfaction Profile (SAT-P), and comparing the baseline hormonal level with the final one. After 12 weeks of treatment, both ezetimibe- and nutraceutical-treated patients experienced a significant improvement in low-density lipoprotein cholesterolaemia and triglyceridaemia (both p<0.05) and a significant increase in IIEF-5 score (p<0.05 for both). However, patients taking the nutraceutical experienced a more significant increase than the group taking ezetimibe (1.2±0.7 vs. 0.7±0.3, p=0.04). Both ezetimibe- and nutraceutical-treated subjects experienced a significant improvement in psychological performance-related SAT-P score, but the nutraceutical-treated group’s improvement was larger than that of the ezetimibe-treated group (+8±4 vs. +6±3, p<0.05). Moreover, only the nutraceutical-treated patients experienced a significant improvement in physical and social performance related SAT-P score compared to the baseline (+7±5 and 6±3, both p<0.05). Our data support the use of alternative lipid-lowering strategies in patients refusing to continue statin consumption because of perceived worsening of erectile function.