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Psychosexual functioning of partners of men with presumed non-organic erectile dysfunction: cause or consequence of the disorder?

In the treatment of couples where the male partners have erectile dysfunction (ED) it often becomes apparent that characteristics of the female partners and of the relationship in general have contributed to the problem. However, this has received little research attention. We investigated female partners of men with ED where no organic cause could be found (n = 34) and partners of men with organically based ED (n = 71) to compare their views on their relationships, sexual function, sexual attitudes, and psychological adjustment. Relationship problems and the psychosexual dysfunctions of vaginismus and dyspareunia were more common in the partners of men with nonorganic ED; they also reported higher levels of sexual interest. Female sexual dysfunctions in the nonorganic ED group had usually preceded the onset of the erectile difficulties. While belief in male sexual myths was substantial in both groups of patients, neither the presence of traditional views on sexuality nor psychological complaints distinguished partners of men experiencing nonorganic ED from those with organic ED. Relationship problems, female psychosexual dysfunction, and the possible effect of relatively high levels of female sexual interest may contribute to the onset, exacerbation, and maintenance of ED. These should be addressed during assessment and treatment of couples in which the male partners have erectile difficulties.

Adult↗

Efficacy and safety of oral sildenafil citrate (Viagra) in the treatment of male erectile dysfunction in Colombia, Ecuador, and Venezuela: a double-blind, multicenter, placebo-controlled study.

The objective of this work was to assess the efficacy and safety of sildenafil in patients with erectile dysfunction (ED) from Colombia, Ecuador, and Venezuela. One hundred and fifty-eight outpatients with ED participated in a double-blind, flexible-dose, randomized-controlled trial. Efficacy measures included question 3 (achieving an erection) and question 4 (maintaining an erection) from the International Index of Erectile Function (IIEF), the five functional domains of the IIEF, a global efficacy question, and patient event log. Sildenafil increased patients' ability to achieve/maintain erections (P<0.01). Seventy-seven per cent of sildenafil- vs 46% of placebo-treated patients reported improved erections (P<0.001). Sixty-five percent and 35% of intercourse attempts were successful among sildenafil and placebo patients, respectively (P<0.05). Sildenafil patients showed significant improvements in three of the five IIEF functional domains (P<0.05). Adverse events were reported for 51% and 33% of sildenafil and placebo patients, respectively. It can be concluded that sildenafil is an effective, well-tolerated treatment for ED in patients from Latin America.

Administration, Oral↗

Long-term efficacy and compliance of intracorporeal (IC) injection for erectile dysfunction following radical prostatectomy: SHIM (IIEF-5) analysis.

Baseline and follow-up data from 102 patients using intracorporeal (IC) injection for erectile dysfunction (ED) following RP were retrospectively collected. We compared baseline International Index for Erectile Function (IIEF) questionnaires with the abridged IIEF-5 questionnaires, referred to as the Sexual Health Inventory of Men (SHIM) to determine drug efficacy. The mean presurgery SHIM score was 21.75+/-5.23, which decreased to 4.23+/-3.48 after surgery and increased to 19.46+/-8.78 post-treatment. Overall, 68% (69/102) of patients achieved and maintained erections sufficient for sexual intercourse and 48% (49/102) of patients continued long-term therapy with a mean use of 3.7+/-1.9 y. In all, 52% (53/102) patients discontinued IC therapy. However when excluding patients who switched to oral therapy, had loss of partner or return of normal erections; the compliance to IC injections was 70.6% (71/102). There was no difference in the SHIM analysis between the nerve sparing (NS) and the non-NS or between the types of medications used. IC injections can provide excellent long-term efficacy and compliance in up to 70% of the patients. This study suggests that IC injections are an excellent salvage option in NS patients who fail oral therapy and a first option in patients with non-NS procedures.

Aged↗

Hypertension, stress and erectile dysfunction: potential insights from the analysis of heart rate variability.

Increased sympathetic activity and mental stress may affect erectile function. These effects may be acute and/or chronic. Cardiovascular regulation can be assessed non-invasively using a computer-based analysis of suitable haemodynamic signals. This research may provide new insights into the complex pathogenesis of erectile dysfunction (ED). In particular, there is still a largely unexplored area of research that covers the effect of drugs on these regulatory mechanisms. Such research may provide new therapeutic options.

Autonomic Nervous System↗

Therapeutic effectiveness and patient satisfaction after 6 months of treatment with tadalafil, sildenafil, and vardenafil: results from the erectile dysfunction observational study (EDOS).

OBJECTIVE: This observational study was conducted across Europe to assess health outcomes in men with erectile dysfunction (ED) who took tadalafil, sildenafil citrate (sildenafil), or vardenafil HCl (vardenafil) for 6 mo. METHODS: Therapy effectiveness and patient satisfaction were evaluated using established and new questions on erectile function. Behavioural, psychological, and relationship outcomes were assessed using the short form of the Psychological and Interpersonal Relationship Scales (SF-PAIRS). RESULTS: In nine European countries at 904 sites, 8047 patients were enrolled and 94% (7560) selected either tadalafil (5315), sildenafil (1252), or vardenafil (993) for treatment at baseline. Of the 7560, 3998 (52.9%) took the same drug for 6 mo. Baseline characteristics across the three treatment groups were comparable: mean age approximately 56 yr, moderate or severe ED, and mean International Index of Erectile Function-Erectile Function domain score about 13. Tadalafil, sildenafil, and vardenafil were therapeutically effective and improved patient satisfaction in the 40-58% of men who completed 6 mo of a single therapy. Patients taking tadalafil consistently had numerically higher levels of therapeutic effectiveness and satisfaction compared with patients who took sildenafil or vardenafil. The three cohorts had statistically significant changes from baseline in response to SF-PAIRS and there were significant differences, in favour of tadalafil, among cohorts in the Time Concerns domain. CONCLUSION: In a large observational study that mimics a routine clinical setting, most patients selected an inhibitor of phosphodiesterase 5 to treat ED, which resulted in a high level of therapeutic effectiveness and patient satisfaction.

Carbolines↗

Regenerative medicine in andrology: Tissue engineering and gene therapy as potential treatment options for penile deformations and erectile dysfunction.

Tissue engineering and gene therapy are currently investigated in animal studies for reconstructing penile tissue or treating erectile dysfunction. This review aims to examine these experimental efforts from the last years and tries to give a brief introduction to the basic methodology of these new techniques from the field of regenerative medicine.

Andrology↗

Trazodone: a double-blind, placebo-controlled, randomized study of its effects in patients with erectile dysfunction without major organic findings.

UNLABELLED: This study examined the efficacy of trazodone 200 mg/day in patients with erectile dysfunction (ED) without major organic findings. PATIENTS AND METHODS: Thirty-four patients with ED without major organic findings entered a double-blind, placebo-controlled, randomized two-centre trial comparing placebo and trazodone 200 mg/day. After a 2 week treatment-free, baseline period eligible patients entered a 4 week treatment-phase. Nocturnal erectile activity was measured before and after treatment by Rigiscan Plus. Sexual desire, quality of partner relation and depressive symptomatology were assessed with the derogatis sexual functioning inventory (DSFI), the dyadic adjustment scale (DAS) and the Hamilton depression rating scale (HDRS), respectively. Sexual function during the study period was assessed with patient diaries. Compliance was measured by trazodone serum concentrations. There were no significant differences between trazodone and placebo in total erection duration, change in sexual desire, report of morning erections or psychometric scales, except for the HDRS. Trazodone serum levels indicated that half of the patients were not compliant. In conclusion, Trazodone 200 mg/day has no effect on sexual function in men with ED without major organic findings and non-compliance was an important issue in the present study.

Adolescent↗

EAU Guidelines on erectile dysfunction: an update.

The introduction of new oral therapies has completely changed the diagnostic and therapeutic approach to erectile dysfunction. A panel of experts in this field has developed guidelines for the clinical evaluation and treatment based on the review of available scientific information.

Erectile Dysfunction↗

Erectile dysfunction in cyclic GMP-dependent kinase I-deficient mice.

The generation of nitric oxide (NO) in penile erectile tissue and the subsequent elevation of cyclic GMP (cGMP) levels are important for normal penile erection. Current treatments of erectile dysfunction elevate either cGMP levels by blocking cGMP degrading phosphodiesterase 5 or cyclic AMP (cAMP) levels by intrapenile injection of prostaglandin E1. The molecular target or targets of cGMP in erectile tissue and the role of cAMP for normal penile erection are not known. Herein, we report that mice lacking cGMP-dependent kinase I (cGKI) have a very low ability to reproduce and that their corpora cavernosa fail to relax on activation of the NO/cGMP signaling cascade. Elevation of cAMP by forskolin, however, induces similar relaxation in normal and cGKI-null corpus cavernosum. In addition, sperm derived from cGKI-null mice is normal, can undergo acrosomal reactions, and can efficiently fertilize eggs. Altogether, these data identify cGKI as the downstream target of cGMP in erectile tissue and provide evidence that cAMP signaling cannot compensate for the absence of the cGMP/cGKI signaling cascade in vivo.

Animals↗

[Regenerative medicine in andrology: tissue engineering and gene therapy as potential treatment options for penile deformations and erectile dysfunction].

Tissue engineering and gene therapy are currently investigated in animal studies for reconstructing penile tissue or treating erectile dysfunction. This review aims to ecamine these experimental efforts from the last years and tries to give a brief introduction to the basic methodology of these new techniques from the field of regenerative medicine.

Animals↗

Health-related quality of life in a UK-based population of men with erectile dysfunction.

OBJECTIVE: To measure health-related quality of life (HR-QOL) among a sample of men with erectile dysfunction (ED) in the UK. STUDY POPULATION AND METHODS: A structured questionnaire was mailed to a sample of 5000 men in the UK with ED. The questionnaire included the International Index of Erectile Function (IIEF-5) scale to determine ED severity and the EuroQoL (EQ-5D) questionnaire, a generic HR-QOL instrument. Descriptive information relating to personal relationships and sociodemographics as well as details of comorbidities were also requested. RESULTS: 23% of the sample (n = 1141) returned a completed questionnaire. Of the respondents, 82.2% (n = 939) met the criteria for ED based on the IIEF-5 scale. The mean age of the respondents was 60.4 +/- 24.9 years. There was a gradual convergence of respondents' HR-QOL scores to that of the normal male population as their age increased. The HR-QOL of respondents was significantly poorer than that of the normal population for those under 65 years of age, whereas it was significantly better for those between the ages of 65 and 74 years. Comorbid illness had a significant impact on the HR-QOL of respondents over 44 years of age. Furthermore, the HR-QOL of respondents with multiple risk factors for ED was significantly lower than that of respondents without any risk factors (p < 0.001). The respondents' HR-QOL was significantly poorer compared with the normal male population when stratified by marital status. It was also significantly poorer when stratified by whether the respondents were manual or non-manual workers. CONCLUSION: HR-QOL among men with ED is poorer in those with comorbid illnesses and improves with age.

Adult↗

Sildenafil citrate (Viagra) is effective and well tolerated for treating erectile dysfunction of psychogenic or mixed aetiology.

Sildenafil citrate (Viagra) has been shown to be an effective treatment for erectile dysfunction (ED) of organic aetiology. This study assessed the efficacy and tolerability of sildenafil for treating ED of psychogenic and mixed psychogenic/organic aetiology. Men with ED of psychogenic and mixed aetiology were randomised in a double-blind, fixed-dose study to placebo (n = 95) or sildenafil 10 mg (n = 90), 25 mg (n = 85), or 50 mg (n = 81) once daily for 28 days. Efficacy was evaluated with two global efficacy questions, a patient log of erectile activity, a sexual function questionnaire and a partner questionnaire. Patients receiving sildenafil had significantly more grade 3 (hard enough for penetration) or grade 4 (fully hard) erections per week than patients receiving placebo, and a greater proportion of patients receiving sildenafil reported that treatment had improved their erections (p < 0.001). Results of the sexual function questionnaire demonstrated significant improvement for patients with ED receiving sildenafil compared with patients receiving placebo for frequency, hardness and duration of erections (p < 0.01), and for enjoyment of sexual intercourse and satisfaction with sex life (p < 0.05). The results of the partner questionnaire were consistent with the results reported by patients and showed that treatment with sildenafil was associated with significant improvement in the partners' own sex lives (p < 0.001). Adverse events were mostly mild to moderate in nature. The commonest adverse events were headache, dyspepsia, flushing, myalgia, arthralgia and flu syndrome. Discontinuations due to treatment-related adverse events were few, ranging from 1.1% to 6.2% for patients receiving different doses of sildenafil and 4.2% for patients receiving placebo. Sildenafil is an effective and well-tolerated treatment for ED of psychogenic or mixed aetiology with once-daily dosing.

Adolescent↗

Severe erectile dysfunction is a marker for hyperprolactinemia.

The need for routine prolactin (PRL) measurement in the initial evaluation of erectile dysfunction (ED) has been questioned because of the low rate of hyperprolactinemia (HP) in these men and the costs involved. In addition, it is widely thought that sexual desire problems are a good clinical marker for HP and/or low testosterone in men with ED. Within a 15-month period, 844 consecutive PRL and sexual hormone determinations were conducted in men at the Kingston General Hospital. Of these patients, 138 were comprehensively evaluated at the first visit for ED and completed the International Index of Erectile Function (IIEF). In the 138 patients, 2.2% had severe hyperprolactinemia (>35 ng/ml), within the range of 1-5% previously reported. No correlation between initial prolactin value and the sexual desire domain or the erectile function domain (EFD) of the IIEF was found for this population. However, all cases of severe HP were found to occur in men who scored less than 10 in the EFD of the IIEF. Low libido is widely accepted as a marker of HP. In this study, HP was found in patients not reporting major problems with a desire disorder. Clinically significant HP may be reliably found with routine biochemical evaluation and in this series was not detected in patients with EFD scores above 10. A routine PRL measurement is inexpensive and early detection of a serious and treatable disease may afford greater therapeutic success.

Adult↗

Prevalence and correlates of erectile dysfunction in a population-based study in Belgium.

OBJECTIVES: This study aims to estimate the prevalence of erectile dysfunction (ED) in the male population of Belgium, and to study its correlation with education, the international prostate symptom scale (IPSS), sexual activity, depression, body mass index, alcohol, smoking, easiness to discuss ED with a doctor, current health index, physical activity, hypertension, diabetes, cardiovascular disease, professional status, residence and whether or not the respondent lives alone. METHODS: An age-stratified random sample of the male population aged 40-70 years of Ghent and Charleroi was interviewed in the home by a trained, experienced male nurse, using a structured interview that included the international index of erectile function (IIEF) and the IPSS. ED was classified by the subjects' self-reported confidence to achieve and maintain an erection. RESULTS: In total, 799 men were interviewed, with a participation rate of 38.0%. The overall age-adjusted prevalence of ED was 10.1% severe, 24.7% moderate, 26.6% mild, and 38.7% reported no ED. Age and the absence of sexual activity over the last 4 weeks were the strongest correlates of ED. Other strong correlates were four or more health complaints, depression, a high score for the IPSS and absence of physical activity. DISCUSSION: The prevalence of ED in Belgium is comparable with the results of other population-based studies for severe and moderate ED. Sexual inactivity over the last four weeks is a strong correlate of ED, and should make the clinician think of a possible problem of ED.

Adult↗

Prevalence of erectile dysfunction and its correlates: a population-based study in Morocco.

To obtain data on the prevalence of erectile dysfunction (ED) and its correlates, along with help-seeking behaviour, 655 randomly selected men at least 25 y old, residing in Casablanca, Morocco, were recruited. They responded to a questionnaire administered by five trained sociologist interviewers. Information on demographics, concomitant diseases, drugs, and sexual activity was collected. ED was prevalent in 54%, increased noticeably with age, and was highly prevalent between both the illiterate and those employed. Risk factors were diabetes, hypertension, heart disease, and smoking. Limited sexual satisfaction, low frequency of intercourse, and a disturbed psychological state with depressed mood had negative effects on erectile function. Given its prevalence in our country, ED should be considered an important medical problem with a multifactorial aetiology, making the cooperation of a multidisciplinary management team highly recommended.

Adult↗

Drivers and barriers to seeking treatment for erectile dysfunction: a comparison of six countries.

OBJECTIVE: To identify predictors of treatment-seeking behaviour in men with erectile dysfunction (ED) and the predictors (correlates) of individual drivers and barriers to seeking treatment. Although the prevalence and epidemiology of ED have been reviewed, there is little information about the treatment-seeking behaviour of men with this disorder. SUBJECTS AND METHODS: Data from the Cross-National Survey on Male Health Issues conducted between March and September 2000 were assessed by multivariate analysis. A cohort of 32 644 men aged 20-75 years was recruited during visits to their physicians. The men completed a short screening questionnaire, covering their overall health, and prostate, urinary and erectile problems. Men identified as having ED completed a detailed follow-up questionnaire. Logistic regression methods were used to identify predictors of treatment-seeking behaviour, and individual drivers and barriers to seeking treatment. RESULTS: Most men with ED had not sought treatment. The analyses suggested that ED, in conjunction with a desire to have sex, was necessary for men to seek treatment. Men seeking treatment commonly identified themselves as self-motivated or that they were influenced by a spouse or sex partner. The youngest group (20-39 years) was least likely to seek treatment. Among those who did not seek treatment, younger men were likely to believe that their ED would resolve spontaneously, whereas older men resisted seeking treatment because they felt that ED was a natural part of ageing. CONCLUSIONS: The data from this survey of men using the healthcare system confirmed other population-based reports that a minority of men with ED seek treatment. Subset analyses showed that treatment-seeking behaviour tended to be driven primarily by the man or by his sex partner. Common barriers to seeking treatment included the belief that ED would resolve spontaneously (younger men) and that ED was a normal part of ageing (older men).

Age Distribution↗

Factors associated with erectile dysfunction in male kidney transplant recipients.

A transversal study was carried out in order to evaluate the prevalence of erectile dysfunction (ED) in adult kidney transplant patients of our region (N=243), and to investigate the sociodemographic, analytic, and clinical factors associated with it. To evaluate ED, the Spanish five items version of the International Index of Erectile Function (IIEF-5) was employed. Sociodemographic, analytic, and clinical data, including 12 cardiovascular risk factors, were also collected. A total of 199 patients (82%) were included. The median age was 52 y (43-62 y); 106 patients (54.9%) presented with ED. Variables associated with ED were: higher age; longer time on dialysis prior to transplantation; higher comorbidity; presence of diabetes mellitus; had undergone prostatic surgery or peripheric artheriopathy; lower diastolic pressure; and some anti hypertensive drugs. Logistic Regression Model performed step by step showed (R(2)=0.52) that factors independently associated with ED were: age, time on dialysis previous to transplant, and peripheric artheriopathy.

Adult↗

Assessment of erectile dysfunction in diabetic men: the clinical relevance of self-reported sexual functioning.

Diabetes mellitus is commonly associated with erectile dysfunction (ED). Fifty-three diabetic male veterans presenting with ED underwent an extensive medical examination, psychological evaluation, and a detailed assessment of sexual functioning. They then underwent two consecutive nights of inhospital Rigiscan monitoring to assess erectile capacity. Multivariate analyses indicated that patient reports of a.m. erections and erectile quality were highly predictive of Rigiscan measures of penile tip and base rigidity and duration of erectile episodes. These results highlight the importance of attending to patient reports of specific sexual symptomatology in the evaluation of diabetic patients presenting with ED.

Adult↗