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Biomedical subjects

Raymond Rosen

Publications and source records attributed to Raymond Rosen.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: from the male attitudes regarding sexual health survey.

INTRODUCTION: Most U.S. population-based estimates of erectile dysfunction (ED) prevalence restricted upper age, were not nationally representative, or underrepresented minority groups. AIM: To estimate, by race/ethnicity in the United States, the prevalence of ED and the impact of sociodemographic, health, relationship, psychological, and lifestyle variables. METHODS: This cross-sectional, population-based, nationally representative probability survey conducted between May 2001 and January 2002 in the general community setting facilitated equivalent representation among U.S. non-Hispanic white (N = 901), non-Hispanic black (N = 596), and Hispanic (N = 676) men aged 40 and older by using targeted phone lists to oversample the minority populations. MAIN OUTCOME MEASURE: Estimated prevalence of moderate or severe ED, defined as a response of "sometimes" or "never" to the question "How would you describe your ability to get and keep an erection adequate for satisfactory intercourse?" RESULTS: The estimated prevalence was 22.0% (95% confidence interval [CI], 19.4-24.6) overall, 21.9% (95% CI, 18.8-24.9) in whites, 24.4% (95% CI, 18.4-30.5) in blacks, and 19.9% (95% CI, 13.9-25.9) in Hispanics, and increased with increasing age. The odds ratio increased with increasing age. Probability also increased with diabetes, hypertension, and moderate or severe lower urinary tract symptoms (LUTS) overall; age > or =70 years and diabetes in whites; severe LUTS in blacks; and age > or =60 years, moderate LUTS, hypertension, and depression in Hispanics. It decreased with exercise and college vs. less than high school education overall; with exercise, good relationship quality, and according to alcohol intake in blacks; and with high school or college education in Hispanics. CONCLUSIONS: The odds of ED increased with increasing age across race/ethnicity when controlling for sociodemographic, health, relationship, psychological, and lifestyle variables. These initial analyses suggest further study of the interrelationships among risk factors for ED.

Adult↗
PubMed2006

Vulvodynia: characteristics and associations with comorbidities and quality of life.

OBJECTIVE: This case-control survey compared health history and health care use of women with vulvodynia with a control group reporting absence of gynecologic pain. METHODS: Women with a clinically assessed diagnosis of vulvodynia and asymptomatic controls were matched for age and mailed a confidential survey that evaluated demographics, health history, use of the health care system, and history of vulvodynia. Participants were all current or former ambulatory patients within a university health care system. RESULTS: Of the 512 questionnaires mailed to valid addresses, 70% (n = 91) of cases and 72% (n = 275) of controls responded, with 77 cases and 208 controls meeting eligibility criteria. Women with vulvodynia reported a substantial negative impact on quality of life, with 42% feeling out of control of their lives and 60% feeling out of control of their bodies. Forty-one percent indicated a severe impact on their sexual lives. When comorbidities were evaluated individually and adjusted for age, fibromyalgia (odds ratio 3.84, 95% confidence interval 1.54-9.55) and irritable bowel syndrome (odds ratio 3.11, 95% confidence interval 1.60-6.05) were significantly associated with vulvodynia. On a multivariate level, vulvodynia was correlated with a history of chronic yeast vaginitis and urinary tract infections. CONCLUSION: This survey highlights the psychological distress associated with vulvodynia and underscores the need for prospective studies to investigate the relationship between chronic bladder and vaginal infections as etiologies for this condition. As well, the association of vulvodynia with other comorbid conditions, such as fibromyalgia and irritable bowel syndrome, needs to be further evaluated. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2006

Sexual communication skills in residency training: the Robert Wood Johnson model.

Few medical schools or residency programs offer adequate training in sexual medicine. Using the experience gained in our long-standing program in human sexuality for medical students, we have pilot tested a half-day intensive workshop curriculum for residents that focuses on sexual communication skills and management of sexual problems. Unlike our medical school program, this residency course was offered on an elective, one-day basis. The current report describes the successful implementation of our pilot program with 46 medical residents from subspecialty and primary care residency programs. Before the workshop, 22 (48%) residents indicated that they were uncomfortable with open discussion of sexual issues and would not feel comfortable in addressing the topic with their patients. A number of factors were identified as barriers to communication, including lack of time, inadequate training, and personal discomfort. After the workshop, the participants rated themselves as more comfortable with the topic and as more likely to address sexual issues with their patients. The participants evaluated the workshop positively overall and responded well to the interactive format and audience-response components. Most of the participants showed interest and willingness to participate in further training in sexual medicine skills. Our program offers a model for training of residents in communication skills and management of sexual problems. The difficulties in implementation and overcoming institutional barriers to curriculum reform are addressed.

Curriculum↗
PubMed2006

Satyriasis: the antiquity term for vulvodynia?

From ancient times, through the Middle Ages, and well into the 19th century, physicians concentrated on catastrophic medical conditions and illnesses rather than on quality of life issues. Wars, plagues, and pestilence left little time, energy, or concern for "discomfort" problems. Therefore, it is not surprising that women's conditions that caused distressing symptoms but fell short of major morbidity and mortality were not given a prominent position in medicine until relatively recently. This is especially the case with vulvodynia, a condition that has been reported to affect approximately 15% (and in some studies up to 27%) of the female population at some point in their lives. Despite its high prevalence, this condition was not discussed or reported in traditional medical textbooks until the end of the 1800s. Now, we propose another viewpoint on when the first description of vulvodynia appeared; that is, that vulvodynia was described as far back as the 1st century CE. From our review of the ancient medical literature, we believe that the condition described by Soranus as "satyriasis in females" was actually vulvodynia.

Dyspareunia↗
PubMed2006

Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation.

INTRODUCTION: No validated questionnaires to assess the subjective aspects of premature ejaculation (PE) are currently in use. Clinical trials have generally only considered time, measured by ejaculatory latency, as an indicator of efficacy, but ejaculatory control, sexual satisfaction, and distress are important aspects of PE, which impact both the patient and his partner. The objective of this study was to develop and validate a new questionnaire to measure the overall experience of PE. METHODS: The questionnaire was developed using four stages: item pool development, initial psychometric analyses, patient interviews, and final psychometric analyses. RESULTS: An item pool of 17 was generated and reduced to 10 items through the initial psychometric analyses. Patient interviews did not require addition of further items and resulted in only minor modifications to item wording for clarity. Final psychometric analyses of the 10-item measure confirmed a three-factor solution: sexual satisfaction, control, and distress. Reliability was good, both internal consistency and test-retest reliability. Convergent validity using intravaginal ejaculatory latency time was excellent: control domain (0.75), sexual satisfaction domain (0.60), and distress domain (0.68). Known-groups validity was very good, all domain mean scores being statistically significantly worse in men with PE compared with the men reporting no PE problems. CONCLUSION: The Index of Premature Ejaculation is a reliable and valid questionnaire for the assessment of control over ejaculation, satisfaction with sex life, and distress in men with PE. This tool has the potential to add value to interpretations of improvements in ejaculation latency resulting from new treatments of PE.

Adult↗
PubMed2006

Efficacy and tolerability of vardenafil in men with mild depression and erectile dysfunction: the depression-related improvement with vardenafil for erectile response study.

OBJECTIVE: Erectile dysfunction and depression are highly associated. Previous studies have shown benefits of phosphodiesterase-5 inhibitor treatment for erectile dysfunction associated with antidepressant therapy or subsyndromal depression. The present study assessed the safety and efficacy of vardenafil in men with erectile dysfunction and untreated mild depression. METHOD: In this 12-week, multicenter, randomized, flexible-dose, parallel-group, double-blind study, 280 men with erectile dysfunction for at least 6 months and untreated mild major depression received placebo or vardenafil, 10 mg/day, for 4 weeks, with the option to titrate to 5 mg/day or 20 mg/day after each of two consecutive 4-week intervals. Endpoints included International Index of Erectile Function erectile function domain and 17-item Hamilton Depression Rating Scale (HAM-D) scores. RESULTS: Vardenafil produced statistically significant and clinically meaningful improvement in all erectile function parameters. The International Index of Erectile Function erectile function domain score was 22.9 with vardenafil compared to 14.9 with placebo. The HAM-D score was lower in the vardenafil group (7.9) than in the placebo group (10.1). Treatment with vardenafil was the most important predictor for return to normal erectile function. Improvement in International Index of Erectile Function erectile function domain score was the most important predictor of remission in depressive symptoms. CONCLUSIONS: Vardenafil was well tolerated and highly efficacious in men with erectile dysfunction and untreated mild major depression. Significant improvements in erectile function and depression were observed in patients treated with vardenafil versus placebo. Erectile dysfunction treatment should be considered a component of therapy for men with depression and erectile dysfunction.

Comorbidity↗
PubMed2006

Chronic vulvar and other gynecologic pain: prevalence and characteristics in a self-reported survey.

OBJECTIVE: To characterize and assess the prevalence of chronic gynecologic pain and, more specifically, chronic vulvar pain. STUDY DESIGN: A questionnaire was mailed to women aged 18-80 years who were ambulatory patients at an academic multidisciplinary practice. Quality of life, health history, obstetric and gynecologic history, and pain symptoms were assessed. RESULTS: Of the 4,872 surveys mailed to deliverable addresses, 36.8% were returned. The population was primarily Caucasian (83%), with an average age of 50.2 years. Approximately 4% of respondents reported a history of vulvar pain in the 6 months preceding the survey, and 17% reported other types of chronic gynecologic pain. Women reporting vulvar and nonvulvar pain were 2 times as likely as asymptomatic women to report a history of depression and vaginal infections, a poorer quality of life (p < 0.001) and greater stress. Dyspareunia and pain with daily activities were reported more frequently by women with vulvar pain than by women with non-vulvar gynecologic pain. CONCLUSION: The prevalence of vulvar pain in this study was lower than previously reported. Chronic gynecologic pain, and vulvar pain in particular, affects quality of life on both intimate and social levels. Self-reported stress and vaginal infections were the strongest correlates of chronic vulvar pain.

Adolescent↗
PubMed2006

Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management.

Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population. Despite its high prevalence and associated distress, the etiology, diagnosis and clinical management of the disorder have not been clearly delineated. This "white paper" describes the findings and recommendations of a consensus conference panel based on a comprehensive review of the published literature on vulvodynia in addition to expert presentations on research findings and clinical management approaches. The consensus panel also identified key topics and issues forfurther research, including the role of inflammatory mechanisms and genetic factors and psychosexual contributors.

Biomedical Research↗
PubMed2005

Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference).

Recent studies have highlighted the relation between erectile dysfunction (ED) and cardiovascular disease. In particular, the role of endothelial dysfunction and nitric oxide in ED and atherosclerotic disease has been elucidated. Given the large number of men receiving medical treatment for ED, concerns regarding the risk for sexual activity triggering acute cardiovascular events and potential risks of adverse or unanticipated drug interactions need to be addressed. A risk stratification algorithm was developed by the First Princeton Consensus Panel to evaluate the degree of cardiovascular risk associated with sexual activity for men with varying degrees of cardiovascular disease. Patients were assigned to 3 categories: low, intermediate (including those requiring further evaluation), and high risk. This consensus study from the Second Princeton Consensus Conference corroborates and clarifies the algorithm and emphasizes the importance of risk factor evaluation and management for all patients with ED. The panel reviewed recent safety and drug interaction data for 3 phosphodiesterase (PDE)-5 inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease. Increasing evidence supports the role of lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease. Special management recommendations for patients taking PDE-5 inhibitors who present at the emergency department and other emergency medical situations are described. Finally, further research on the role of PDE-5 inhibition in treating patients with other medical or cardiovascular disorders is recommended.

Cardiovascular Diseases↗
PubMed2005

Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference).

Recent studies have highlighted the relation between erectile dysfunction (ED) and cardiovascular disease. In particular, the role of endothelial dysfunction and nitric oxide in ED and atherosclerotic disease has been elucidated. Given the large number of men receiving medical treatment for ED, concerns regarding the risk for sexual activity triggering acute cardiovascular events and potential risks of adverse or unanticipated drug interactions need to be addressed. A risk stratification algorithm was developed by the First Princeton Consensus Panel to evaluate the degree of cardiovascular risk associated with sexual activity for men with varying degrees of cardiovascular disease. Patients were assigned to 3 categories: low, intermediate (including those requiring further evaluation), and high risk. This consensus study from the Second Princeton Consensus Conference corroborates and clarifies the algorithm and emphasizes the importance of risk factor evaluation and management for all patients with ED. The panel reviewed recent safety and drug interaction data for 3 phosphodiesterase (PDE)-5 inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease. Increasing evidence supports the role of lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease. Special management recommendations for patients taking PDE-5 inhibitors who present at the emergency department and other emergency medical situations are described. Finally, further research on the role of PDE-5 inhibition in treating patients with other medical or cardiovascular disorders is recommended.

Age Distribution↗
PubMed2005

Lower urinary tract symptoms and male sexual dysfunction in Asia: a survey of ageing men from five Asian countries.

OBJECTIVE: To determine, using the Asian Survey of Aging Males (ASAM), the prevalence of lower urinary tract symptoms (LUTS) and sexual disorders in Asian men aged 50-80 years, and to investigate the relationship between LUTS and sexual dysfunction, as community-based studies have shown a relationship between LUTS and sexual dysfunction. SUBJECTS AND METHODS: The ASAM survey was conducted in selected cities in five Asian countries, using a combination of face-to-face and mail-survey methods. The survey evaluated demographics, urinary symptoms (using the International Prostate Symptom Score, IPSS, and bother score), functional problems (using the Danish Prostatic Symptoms Score, DAN-PSS-Sex, and International Index of Erectile Function, IIEF) and comorbidity factors. In all, 1155 men aged 50-80 years completed the survey. RESULTS: The prevalence of LUTS varied among the countries, ranging from 14% in Singapore to 59% in the Philippines. Moderate to severe LUTS were reported by 36% of men aged 50-59 years, 50% aged 60-69 years and 60% aged 70-79 years. About three-quarters of all respondents (72%) aged 50-80 years were sexually active. Erectile dysfunction was reported by 63% of men in the study, of whom 57% were bothered by their symptoms. Ejaculation disorders were present in 68% of respondents (52% reported bothersomeness) and pain on ejaculation was experienced by 19% of the men in the study (88% reported bothersomeness). Sexual disorders increased with age and increasing severity of their LUTS. Erectile and ejaculation problems were more common in subjects with diabetes or hypertension; these two groups showed the same relationship between LUTS severity and sexual disorders. CONCLUSION: These results confirmed that sexual activity is common in Asian men aged 50-80 years, even at an advanced age. They also confirmed the correlation between LUTS and sexual dysfunction.

Age Distribution↗
PubMed2005

Sensitivity of the psychological and interpersonal relationship scales to oral therapies for erectile dysfunction.

INTRODUCTION: Studies of erectile dysfunction (ED) therapies typically assess erectile function end- points, although other treatment outcomes may also be of value to men and their partners. Aim. To examine the treatment sensitivity of the Psychological and Interpersonal Relationship Scales (PAIRS) associated with the use of two phosphodiesterase type 5 (PDE5) inhibitors with different duration of action. METHODS: Men with ED were recruited from three clinical trials of tadalafil and sildenafil citrate to complete post-treatment questionnaires that included the PAIRS. In study 1, the PAIRS was assessed after 6 months of open-label tadalafil (20 mg) treatment and after 2 months of real-world sildenafil use (25-100 mg). In studies 2 and 3, the PAIRS was assessed at the end of the trial assessment phase. In study 2, men with a 6-24 week history of sildenafil use (25-100 mg) received 3 weeks of open-label sildenafil treatment (dosage at study entry), and then switched to 9 weeks of tadalafil treatment. In study 3, a double-blind, crossover study, men were randomized to 12 weeks of either tadalafil (20 mg) or sildenafil (50 mg) treatment, followed by 12 weeks of the alternate treatment; PAIRS scores for the second treatment period were evaluated. MAIN OUTCOME MEASURE: Treatment outcomes were assessed with the PAIRS, a new reliable and valid self-report measure of sexual self-confidence, spontaneity, and time concerns before sex. RESULTS: Significant mean differences were observed on all PAIRS domain scores associated with tadalafil and sildenafil treatment. Across studies, men had significantly higher sexual self-confidence and spontaneity scores, and lower time concerns scores in reference to tadalafil compared with their scores in reference to sildenafil. CONCLUSIONS: Mean differences observed on PAIRS domains across studies support the sensitivity of the measure to differentiate between these two ED treatments.

Adult↗
PubMed2005

Premature ejaculation: an observational study of men and their partners.

INTRODUCTION: Premature ejaculation (PE) is the most common male sexual dysfunction affecting men and their partners. Lack of community-based data describing this condition limits understanding of PE and its outcomes. AIM: To characterize PE in a large population of men with and without PE using patient-reported outcome (PRO) measures elicited from men and their partners. METHODS: 4-week, multicenter, observational study of males (> or =18 years) and their female partners in monogamous relationships (> or =6 months). Screening, baseline, and follow-up visits scheduled at 2-week intervals. Clinicians diagnosed PE utilizing DSM-IV-TR criteria. Intravaginal ejaculatory latency time (IELT), measured by a stopwatch held by the partner, was recorded for each sexual intercourse experience. Subject and partner independently assessed PROs: control over ejaculation and satisfaction with sexual intercourse (0 = very poor to 4 = very good), personal distress and interpersonal difficulty (0 = not at all to 4 = extremely), and severity of PE (0 = none to 3 = severe). Results. Of the total study population (N = 1,587), 207 subjects were diagnosed with PE and 1,380 were assigned to the non-PE group. Median IELT (min) was 1.8 (range, 0-41) for PE and 7.3 (range, 0-53) for non-PE subjects (P < 0.0001). More PE vs. non-PE subjects gave ratings of "very poor" or "poor" for control over ejaculation (72% vs. 5%; P < 0.0001) and satisfaction with sexual intercourse (31% vs. 1%; P < 0.0001). More subjects in the PE vs. non-PE group gave ratings of "quite a bit" or "extremely" for personal distress (64% vs. 4%; P < 0.0001) and interpersonal difficulty (31% vs. 1%; P < 0.0001). Subject and partner assessments showed similar patterns and correlated moderately (0.36-0.57). CONCLUSIONS: PE subjects reported significantly shorter IELT. Overlap in IELT distributions was observed between the PE and non-PE groups, indicating the need for additional PRO measures to characterize PE. Shorter IELT was significantly associated with reduced ejaculatory control and sexual satisfaction and increased distress and interpersonal difficulty.

Adult↗
PubMed2004

Erection quality scale: initial scale development and validation.

OBJECTIVES: The Erection Quality Scale (EQS) is a new, self-report measure for assessing the quality of penile erections. It is intended to complement existing diagnostic and outcome measures (eg, International Index of Erectile Function, Sexual Encounter Profile) in both clinical practice and outcomes research in erectile dysfunction (ED). METHODS: The initial phases of development and psychometric validation of the EQS are described. Specifically, qualitative research in patients and healthy men was used to generate relevant constructs. On the basis of the findings from these phases, and recommendations from an expert panel, seven constructs were selected for inclusion. Multiple items with different formats were drafted to measure each of the key constructs. An iterative process of cognitive testing, item revision, and item reduction was used to identify the 15 most appropriate items and their optimal response scales. This version of the scale was tested in a 200-subject discriminant validity study designed to gather data for a psychometric evaluation. Participants were classified into ED-untreated, ED-treated, and healthy control groups to evaluate the discriminant validity of the measure in men with different levels of erectile function. RESULTS: The study results supported a robust single-factor structure, indicating that the EQS provides an overall index of erection quality. An intraclass correlation coefficient of 0.85 denotes adequate test-retest reliability. Furthermore, the EQS correlated well with existing measures and differentiated patients from the three ED classifications, a preliminary indication of discriminant validity. CONCLUSIONS: The findings presented provide evidence of the scale's potential utility for measuring erection quality in future studies.

Adult↗
PubMed2004

The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study.

PURPOSE: To identify and model the effects of sleep loss and fatigue on resident-physicians' professional lives and personal well-being. METHOD: In 2001-02, 149 residents at five U.S. academic health centers and from six specialties (obstetrics-gynecology, emergency medicine, family medicine, internal medicine, pediatrics, surgery) were recruited for the study. Residents were all in good standing in their programs. In a mixed-methods design, focus groups consisted of an average of seven (range, three to 14) individuals in the same year of training and residency program, for a total of 60 interns and 89 senior residents. Trained moderators conducted focus groups using a standardized, semistructured discussion guide. Participants also completed a 30-item quantitative questionnaire assessing sleepiness and workplace sleep attitudes that included the Epworth Sleepiness Scale (ESS). RESULTS: Residents described multiple adverse effects of sleep loss and fatigue on learning and cognition; job performance, including professionalism and task performance; and personal life, including personal well-being and relationships with spouse or significant other and family. Only 16% of the sample scored within the "normal" range on the ESS; 84% scored in the range for which clinical intervention is indicated. Sleepiness was consistent across institution, specialty, years of training, age, gender, marital status, and having children. CONCLUSIONS: More residents perceived that sleep loss and fatigue had major impact on their personal lives during residency, leaving many personal and social activities and meaningful personal pleasures deferred or postponed. Sleep loss and fatigue also had major impact on residents' abilities to perform their work. This finding further substantiates the growing concern about the potential impact on professional development. These observations should be taken into account in developing new training guidelines and educational interventions for housestaff.

Adult↗