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PubMed2002

[Prevalence erectile dysfunction in patients with hypertension].

BACKGROUND: Erectile dysfunction (ED), defined as the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance, is closely associated with hypertension. We assessed the prevalence of ED in patients with hypertension at the primary care level. We analyzed factors associated with ED in these patients. We also worked out the relationship between cardiovascular disease risks and ED. PATIENTS AND METHOD: This transversal multicenter study was carried out in educational primary care centers. A total of 512 patients with hypertension completed the International Index of Erectile Function in its abridged form (IIEF-5). Their known cardiovascular risk factors, comorbidity, toxic habits and hypertension history were taken form their medical records. RESULTS: Of 512 patients, 5 were not included in the study because of incomplete data in the IIEF-5 questionnaire. Mean age was 63.36 years (range 30 to 86). The prevalence of erectile dysfunction was 46.5%. Correlation of ED with age [OR = 1.05 (1.028-1.075)], diabetes mellitus [OR = 2.06 (1.247-3.406)] and ischemic heart disease [OR = 3.15 (1.429-6.947)] did reach statistical significance (p < 0.05). A linkage with cardiovascular disease risks, as worked out by the Framingham study, was not found. CONCLUSIONS: We observe a high prevalence of ED in patients with hypertension.

Adult↗

PubMed2006

A prospective study of risk factors for erectile dysfunction.

PURPOSE: We examined the impact of obesity, physical activity, alcohol use and smoking on the development of erectile dysfunction. MATERIALS AND METHODS: Subjects included 22,086 United States men 40 to 75 years old in the Health Professionals Followup Study cohort who were asked to rate their erectile function for multiple periods on a questionnaire mailed in 2000. Men who reported good or very good erectile function and no major chronic disease before 1986 were included in the analyses. RESULTS: Of men who were healthy and had good or very good erectile function before 1986, 17.7% reported incident erectile dysfunction during the 14-year followup. Obesity (multivariate relative risk 1.9, 95% CI 1.6-2.2 compared to men of ideal weight in 1986) and smoking (RR 1.5, 95% CI 1.3-1.7) in 1986 were associated with an increased risk of erectile dysfunction, while physical activity (RR 0.7, 95% CI 0.7-0.8 comparing highest to lowest quintile of physical activity) was associated with a decreased risk of erectile dysfunction. For men in whom prostate cancer developed during followup, smoking (RR 1.4, 95% CI 1.0-1.9) was the only lifestyle factor associated with erectile dysfunction. CONCLUSIONS: Reducing the risk of erectile dysfunction may be a useful and to this point unexploited motivation for men to engage in health promoting behaviors. We found that obesity and smoking were positively associated, and physical activity was inversely associated with the risk of erectile dysfunction developing.

Adult↗

PubMed1999

Randomized trial of sildenafil for the treatment of erectile dysfunction in spinal cord injury. Sildenafil Study Group.

Erectile dysfunction is a common complication of spinal cord injury. This double-blind, placebo-controlled, two-way crossover study assessed the efficacy and safety of oral sildenafil in men with erectile dysfunction caused by traumatic spinal cord injury. A total of 178 men (mean age, 38 years) received placebo or sildenafil 1 hour before sexual activity for 6 weeks; after a 2-week washout period, the men received the alternate treatment for 6 weeks. The 50-mg starting dose could be adjusted to 100 or 25 mg based on efficacy and tolerability. Efficacy was assessed by using global efficacy questions, the International Index of Erectile Function (IIEF), and a patient log of erectile activity. Of 143 men with residual erectile function at baseline, 111 (78%) reported improved erections and preferred sildenafil to placebo. For all men (including those who reported no residual erectile function at baseline), 127 of 168 (76%) reported improved erections and preferred sildenafil to placebo. For all men, 132 of 166 (80%) reported that sildenafil improved sexual intercourse compared with 17 of 166 men (10%) reporting improvement with placebo. IIEF questions assessing the ability to achieve and maintain erections and satisfaction with sexual intercourse demonstrated significant improvement with sildenafil. Sildenafil was well tolerated, with a low rate of discontinuation because of treatment-related adverse events (2% vs 1% for placebo). Oral sildenafil is an effective and well-tolerated treatment for erectile dysfunction caused by spinal cord injury.

Administration, Oral↗

PubMedDate not supplied

Fluvoxamine-induced erectile dysfunction responding to sildenafil.

Sildenafil, a peripherally acting inhibitor of cyclic guanosine monophosphate((cGMP), has been reported highly effective in treating erectile dysfunction of various etiology. Erectile dysfunction is a common sexual side effect of various antidepressants. Various agents have been used in the treatment of antidepressant-induced erectile dysfunction; however, there are no reports on the use of sildenafil for this indication. This case report describes the successful use of sildenafil in fluvoxamine-induced erectile dysfunction. A possible mechanism of action of sildenafil in this type of erectile dysfunction is discussed.

Adult↗

PubMed2005

[Primary artery erectile dysfunction: one case report].

OBJECTIVE: To evaluate the relationship between the deformation of penile artery and the primary artery erectile dysfunction, and to improve the treatment and diagnosis of primary artery erectile dysfunction. METHODS: One case of primary artery erectile dysfunction was presented with its primary clinic data. RESULTS: The dorsal artery of the penis was thin and the bilateral penile arteries were lacking by arteriography. The implantation of a penile prosthesis significantly improved the patient's erectile function. CONCLUSION: The primary artery erectile dysfunction is a relatively rare disease. The possibility of primary artery erectile dysfunction should be kept in mind. Penile prosthesis implantation is an effective means for the treatment of primary artery erectile dysfunction.

Adult↗

PubMed2000

Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study.

PURPOSE: We estimated the incidence of erectile dysfunction in men 40 to 69 years old at study entry during an average 8.8-year followup, and determined how risk varied with age, socioeconomic status and medical conditions. MATERIALS AND METHODS: Data from a randomly sampled population based longitudinal study of Massachusetts men were analyzed. A total of 1,709 men completed the baseline interview during 1987 to 1989 and 1,156 survivors completed followup from 1995 to 1997. The analysis sample consisted of 847 men without erectile dysfunction at baseline and with complete followup information. Erectile dysfunction was assessed by discriminant analysis of 13 questions from a self-administered sexual function questionnaire and a single global self-rating question. RESULTS: The crude incidence rate for erectile dysfunction was 25.9 cases per 1,000 man-years (95% confidence interval [CI] 22.5 to 29.9). The annual incidence rate increased with each decade of age and was 12.4 cases per 1,000 man-years (95% CI 9.0 to 16.9), 29.8 (24.0 to 37.0) and 46.4 (36.9 to 58.4) for men 40 to 49, 50 to 59 and 60 to 69 years old, respectively. The age adjusted risk of erectile dysfunction was higher for men with lower education, diabetes, heart disease and hypertension. Population projections for men 40 to 69 years old suggest that 17,781 new cases of erectile dysfunction in Massachusetts and 617,715 in the United States (white males only) are expected annually. CONCLUSIONS: Although prevalence estimates and cross-sectional correlates of erectile dysfunction have recently been established, incidence estimates were lacking. Incidence is necessary to assess risk, and plan treatment and prevention strategies. The risk of erectile dysfunction was about 26 cases per 1,000 men annually, and increased with age, lower education, diabetes, heart disease and hypertension.

Adult↗

PubMed1995

Subclinical trauma to perineum: a possible etiology of erectile dysfunction in young men.

A substantial number of young men with erectile dysfunction have neither systemic disease nor a trauma in their history. We are familiar with impotence after major trauma but it is an unanswered question whether subclinical trauma may also induce arterial degeneration with subsequent erectile dysfunction. In a period of 36 months 129 patients underwent penile arteriography. After excluding those with major surgery, trauma or psychogenic impotence 91 angiograms were reevaluated. Special attention was paid to atherosclerotic and to focal occlusive arterial disease (> 50% stenosis) in the hypogastric-cavernous branch. 12 angiograms showed normal arteries, 59 typical atherosclerotic and 20 focal occlusive arterial disease. The mean age of patients with atherosclerosis was 53 +/- 8 years versus 35 +/- 14 years of those with focal lesions (p < 0.0001). 30% with focal arterial lesions were subject to subclinical trauma. 68% with atherosclerotic disease had clinical relevant atherosclerotic risk factors. Latency between onset of erectile dysfunction and presentation at the impotence clinic was 51 months in patients with focal lesions and 39 months in those with atherosclerotic disease (nonsignificant). We conclude that subclinical trauma of the hypogatric-cavernous arteries can induce focal arterial lesions with significant impairment of perfusion. This pathology may contribute to erectile dysfunction. These patients are significantly younger and they suffer from clinically evident impotence approximately 18 years earlier than patients whose impotence is clearly of atherosclerotic origin. Focal arterial lesions due to subclinical trauma are described for the first time as an etiology of erectile dysfunction. Further studies are needed to confirm these results.

Adult↗

PubMedDate not supplied

The endocrinologist as the focus in a multidisciplinary approach to management of erectile dysfunction.

OBJECTIVE: To present an approach to the complete but cost-effective office evaluation and treatment of erectile dysfunction. METHODS: The numerous medical, hormonal, and psychologic causes of erectile dysfunction are reviewed, and the various treatment strategies are outlined. RESULTS: Erectile dysfunction, which might also include libido and ejaculatory disturbances, is the most frequently encountered type of sexual dysfunction seen in office practice. Before 1960, the assessment of this disorder was dominated by psychiatrists; later, urologists assumed a role. More recently, physicians in internal medicine have become involved in the management of this problem. Diabetes mellitus, hypertension, and tobacco abuse are the three most common causes of erectile dysfunction in men older than 50 years of age. In addition to optimizing the management of diabetes, the endocrinologist can treat other endocrine problems associated with erectile dysfunction. CONCLUSION: A multidisciplinary approach to the evaluation and treatment of erectile dysfunction is logical, and the endocrinologist--because of an extensive background in internal medicine and expertise in hormonal diagnosis and treatment--should be the focal point of this diagnostic and therapeutic team.

Journal Article↗

PubMed1999

Newer pharmacologic alternatives for erectile dysfunction.

With the introduction of effective pharmacologic therapies for erectile dysfunction, more men are seeking treatment. The underlying cause of erectile dysfunction is usually a chronic medical illness or a side effect of certain drugs. Less commonly, the problem is psychogenic. Even after optimal treatment of common medical disorders such as diabetes mellitus and hypertension, erectile dysfunction may persist. Pharmacologic treatments, such as the intracavernosal or transurethral administration of alprostadil or the use of the new oral medication sildenafil, may offer patients substantial benefit. Before any of these drugs are prescribed, consideration should be given to existing medical illnesses and medications, partner satisfaction, comfort with the method of administration and the side effect profile.

Alprostadil↗

PubMed1998

[Serum and salivary testosterone levels in erectile dysfunction].

In this study 66 male patients with erectile dysfunction were investigated. The authors measured the testosterone levels in serum and in saliva, which latter represent with good accuracy the serum levels of free testosterone. The mean serum total testosterone level was 17.6 nmol/L (confidence intervals: 15.5 and 20.2 nmol/L, normal range: 10-50 nmol/L). The mean salivary free testosterone level was 218.5 pmol/L (confidence intervals: 198.3 and 239.9 pmol/L, normal range: 200-1000 pmol/L). Low salivary (free) testosterone levels were found in 36.4% of patients, while only in 10.6% of patients had low serum testosterone levels (p = 0.01, by binomial test). Although there is a relationship between serum and salivary testosterone levels (r = 0.41, p < 0.001), the patients with low salivary (free) testosterone levels have in major part a normal serum total testosterone level. These data indicate that a considerable proportion of patients with erectile dysfunction have androgen deficiency. The serum total testosterone level is not a sensitive indicator to detection of hypogonadism. The androgen substitution therapy has a beneficial effect on erectile dysfunction in a significant part of patients. The measurement of free testosterone level in saliva may have an important role both in the diagnosis of diseases characterized by androgen deficiency and hyperandrogenic status.

Adult↗

PubMedDate not supplied

Prevalence of cardiovascular risk factors in erectile dysfunction.

OBJECTIVE: Thirty million men in the United States may have erectile dysfunction, and coronary artery disease (CAD) is the major cause of death in men over 55 years old. Several studies have shown a correlation between erectile dysfunction and risk factors for coronary artery disease. Hyperlipidemia plays a pivotal role in CAD, and obesity is now considered an independent risk factor for CAD. Therefore, we attempted to determine the prevalence of obesity and hyperlipidemia, along with other established risk factors such as diabetes, hypertension, and tobacco use, in men with erectile dysfunction. METHODS: Men who had had symptoms of erectile dysfunction for at least six months were recruited from the Center for Sexual Function. Participants underwent detailed clinical interviews, blood analyses, and physical examinations including calculation of body mass index, and they completed a questionnaire on sexual function. RESULTS: Of the 154 men evaluated, 44% had hypertension; 23% had diabetes mellitus; 16% used tobacco; 79% had a body mass index of > 26 kg/m2; and 74% had a low-density lipoprotein cholesterol level of > 120 mg/dL. CONCLUSION: Impotence is an important symptom, and its presence should instigate assessment and aggressive management of coexistent risk factors for CAD. Intervention could restore sexual function and ultimately improve cardiovascular health.

Adult↗

PubMed2006

[Erectile dysfunction and diabetes in Conakry (Guinea): frequency and clinical characteristics from 187 diabetic patients].

Sexual dysfunction is frequent in the diabetic population. In Africa, medical care for erectile dysfunction is underprovided, profoundly altering the quality of life of the patients. We report the prevalence of erectile dysfunction in 187 diabetic patients followed in the department of Endocrinology of the Conakry teaching hospital. Prevalence was estimated from the French version of the International Index of Erectile Function (IIEF). Erectile dysfunction concerned 90 patients (48%) of whom a severe form was observed in 54%, a moderate form in 35% and a mild form in 12%. The patients who presented erectile dysfunction were significantly older, displayed longer duration of diabetes with more complications (sensorial neuropathy and macroangiopathy) and often took drugs for associated cardiovascular diseases. In 28% of the cases, erectile dysfunction was associated with a decline in libido and in 26% with ejaculation disorders. In conclusion, erectile dysfunction is frequent and severe among diabetic patients in Guinea. The medical staff plays an essential role to initiate early diagnosis, promote psychological support and provide medication, if possible.

Aged↗

PubMed2005

[Erectile dysfunction: the role of laboratory in the diagnostic and pronostic evaluation].

OBJECTIVE: To review and to update the different laboratory tests recommended for etiologic diagnostic of erectile dysfunction and to evaluate the effect these tests could have on the pronostic and therapeutic strategy of this pathology. MATERIAL AND METHODS: We review the last articles related with etiopathogenics and pathophysiologics mechanisms of erectile dysfunction, including our studies on endothelial dysfunction and erectile dysfunction. RESULTS: The depth and extension of the laboratory protocol in erectile dysfunction is not necessaryly the same in all situations. The age, coincidence of comorbilities, set a different limit between patients demanding complementaries investigations that go beyond the basic request. CONCLUSIONS: The etiopathogenic laboratory work up in erectile dysfunction is currently changing incorporating news tests. The traditional search of commorbilities like diabetes, hepatic dysfunction, hypogonadism, hyperglucemia is getting broad with recents analitics evaluations related with potential markers of endothelial disease.

Clinical Laboratory Techniques↗

PubMed2001

Sexuality after treatment for early prostate cancer: exploring the meanings of "erectile dysfunction".

OBJECTIVE: To explore perceptions of the impact of erectile dysfunction on men who had undergone definitive treatment for early nonmetastatic prostate cancer. DESIGN: Seven focus groups of men with early prostate cancer. The groups were semistructured to explore men's experiences and quality-of-life concerns associated with prostate cancer and its treatment. SETTING: A staff model health maintenance organization, and a Veterans Affairs medical center. PATIENTS: Forty-eight men who had been treated for early prostate cancer 12 to 24 months previously. RESULTS: Men confirmed the substantial effect of sexual dysfunction on the quality of their lives. Four domains of quality of life related to men's sexuality were identified: 1) the qualities of sexual intimacy; 2) everyday interactions with women; 3) sexual imagining and fantasy life; and 4) men's perceptions of their masculinity. Erectile problems were found to affect men in both their intimate and nonintimate lives, including how they saw themselves as sexual beings. CONCLUSIONS: Erectile dysfunction, the most common side effect of treatment for early prostate cancer, has far-reaching effects upon men's lives. Assessment of quality of life related to sexual dysfunction should address these broad impacts of erectile function on men's lives. Physicians should consider these effects when advising men regarding treatment options. Physicians caring for patients who have undergone treatment should address these psychosocial issues when counseling men with erectile dysfunction.

Aged↗

PubMed1998

Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials.

PURPOSE: Erectile dysfunction is a common problem, particularly in diabetics. It is associated with a considerable burden of suffering. No generally accepted drug treatment exists. We systematically reviewed and meta-analyzed all randomized, placebo controlled trials of yohimbine monotherapy for erectile dysfunction to determine its therapeutic efficacy. Our secondary aim was to evaluate the safety of yohimbine. MATERIALS AND METHODS: We used computerized literature searches and standardized data extraction to rate methodological quality in a meta-analysis using computer statistical software. RESULTS: Seven trials fit the predefined inclusion criteria. Overall methodological quality of these studies was satisfactory. The meta-analysis demonstrated that yohimbine is superior to placebo in the treatment of erectile dysfunction (odds ratio 3.85, 95% confidence interval 6.67 to 2.22). Serious adverse reactions were infrequent and reversible. CONCLUSIONS: The benefit of yohimbine medication for erectile dysfunction seems to outweigh its risks. Therefore, yohimbine is believed to be a reasonable therapeutic option for erectile dysfunction that should be considered as initial pharmacological intervention.

Adrenergic alpha-Antagonists↗

PubMed2003

The etiology of erectile dysfunction and mechanisms by which drugs improve erection.

Following the National Institutes of Health (NIH) consensus conference in 1988, erectile dysfunction is defined as the consistent inability to maintain a penile erection sufficient for adequate sexual relations (1). The advances in basic and clinical research during the last two decades have led to the development of several new treatment options for erectile dysfunction, including new pharmacological agents for intracavernosal, intraurethral and oral use. The recent advent of medical therapy and the poor results of long-term follow-up in reconstructive vascular surgery, have significantly modified the medical management of this disorder. Discussion of erectile dysfunction has increased, information about erectile dysfunction is increasingly available, training in erectile dysfunction was improved and last, but not least, the number of patients seeking help for erectile dysfunction is growing, because satisfactory sexual function is an important part of a couple's healthy relationship and ongoing quality of life.

Adrenergic alpha-Antagonists↗

PubMed2000

Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk?

OBJECTIVES: To prospectively examine whether changes in smoking, heavy alcohol consumption, sedentary lifestyle, and obesity are associated with the risk of erectile dysfunction. METHODS: Data were collected as part of a cohort study of a random sample of men 40 to 70 years old, selected from street listings in the Boston Metropolitan Area, Massachusetts. In-home interviews were completed by 1709 men at baseline in 1987 to 1989 and 1156 men at follow-up in 1995 to 1997 (average follow-up 8.8 years). Analyses included 593 men without erectile dysfunction at baseline, who were free of prostate cancer, and had not been treated for heart disease or diabetes. The incidence of moderate to complete erectile dysfunction was determined by discriminant analysis of responses to a self-administered sexual function questionnaire. RESULTS: Obesity status was associated with erectile dysfunction (P = 0.006), with baseline obesity predicting a higher risk regardless of follow-up weight loss. Physical activity status was associated with erectile dysfunction (P = 0.01), with the highest risk among men who remained sedentary and the lowest among those who remained active or initiated physical activity. Changes in smoking and alcohol consumption were not associated with the incidence of erectile dysfunction (P >0.3). CONCLUSIONS: Midlife changes may be too late to reverse the effects of smoking, obesity, and alcohol consumption on erectile dysfunction. In contrast, physical activity may reduce the risk of erectile dysfunction even if initiated in midlife. Early adoption of healthy lifestyles may be the best approach to reducing the burden of erectile dysfunction on the health and well-being of older men.

Adult↗

PubMed1993

Penile sensitivity in men with premature ejaculation and erectile dysfunction.

Previous research indicates that penile sensitivity is typically lower in men with erectile dysfunction than in age-matched controls. On the assumption that sensitivity might be greater in men with short ejaculation latency (premature ejaculation), the present research investigated penile threshold (sensitivity) to vibrotactile stimulation in men with premature ejaculation, erectile dysfunction, or a combination of the two. Premature ejaculators showed thresholds commensurate with controls, while men with erectile dysfunction, or combined erectile dysfunction and premature ejaculation, showed significantly elevated thresholds. Although premature ejaculators did not show penile hypersensitivity, there was a significant correlation in this group between ejaculation latency and threshold. Overall, these findings argue against a primary role for penile sensitivity in ejaculation latency, and suggest that other somatic factors or cognitive factors may play the more critical role in premature ejaculation.

Adult↗