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PubMed2002

Prevalence and correlates of erectile dysfunction in Salvador, northeastern Brazil: a population-based study.

Our objectives were to determine the prevalence of erectile dysfunction (ED) in Brazil and to explore potential sociodemographic, medical, and lifestyle correlates. A cross-sectional, population-based, household survey was conducted in Salvador, Bahia, Brazil. Cluster samples of representative households were randomly selected for interviews. Of 654 eligible subjects, 602 (92%) participated. A structured questionnaire was administered by trained interviewers. ED was categorized as 'none', 'mild', 'moderate', or 'severe' according to the ability to 'attain and/or maintain an erection satisfactory for sexual intercourse'. All data were obtained by self-report. The age-adjusted prevalence of ED was 39.5% (minimal 25.1%, moderate 13.1%, severe 1.3%). Prevalence and severity increased with age. Having never been married, diabetes, depression, or prostate disease and current depressive or lower urinary tract symptoms were significantly (P<0.05) associated with increased prevalence. Medical, sociodemographic, and lifestyle variables associated with ED may alert physicians to patients at risk for ED and offer insight to its etiology.

Adult↗

PubMed2006

Association among hypogonadism, quality of life and erectile dysfunction in middle-aged and aged male in Taiwan.

The association between hypogonadism, quality of life (QoL), and erectile dysfunction (ED) among the middle-aged and aged male in Taiwan is evaluated. A total of 680 study subjects aged >or=40 years old were recruited from Northern (n=276), Middle (n=238), and Southern (n=202) Taiwan, respectively. ED was diagnosed by score of International Index of Erectile Function (IIEF-5). Taiwan version questionnaire for QoL includes domain 1 (physical domain), domain 2 (psychological domain), domain 3 (social relationship domain), and domain 4 (environmental domain) was used to measure QoL. Blood hormones, including FSH, LH, Prolactin, SHBG, total testosterone (TT), calculated free testosterone (cFT), and bioavailable testosterone (Bio-T), were determined. Logistic regression analysis was used to estimate crude and multivariate-adjusted odds ratio of risk factors and its 95% confidence interval. A significantly inverse association between concentration of serum cFT and Bio-T, and severity of ED was observed. Scores of QoL of Domain 1-4 were significantly decreased with the increament of severity of ED. Significant correlations were found between IIEF scores and four domains of QoL, respectively. After adjustment for age, cFT and Bio-T, study subjects with ED (IIEF<or=21) would have significantly high risk of low level of QoL in four domains. In conclusion, a significant association between low levels of serum calculated cFT, Bio-T, and severity of ED was found. In addition, abnormal erectile function significantly associated with low level of QoL in four domains.

Aged↗

PubMed2001

Characterising the benefit of apomorphine SL (Uprima) as an optimised treatment for representative populations with erectile dysfunction.

The clinical profile for apomorphine sublingual (SL), a new centrally active agent for the management of the erectile dysfunction (ED) patient, is described in this article. Apomorphine SL is shown to be rapid in onset (71% of patients within 20 min) with a consistent, predictable response that is independent of severity (mild, moderate or severe), the underlying aetiology or the presence of significant co-morbidities (coronary artery disease, hypertension, etc). Importantly, there is also consistent long-term clinical benefit (>90% of attempts being successful over 18 months), for patients who respond to therapy and a benign side effect profile (<13.4% patients with adverse events). This formulation of apomorphine has a speed of onset and overall clinical profile that may offer particular advantages to the patient in terms of spontaneity and predictability of response. ED is a complex disease of varying aetiologies and severities often associated with a number of co-morbidities that require diverse solutions. Given the need for customisation of therapy to individual patient needs, the clinical profile of apomorphine SL would indicate that it will make a most welcome addition to the physician's armamentarium against ED.

Administration, Sublingual↗

PubMed2006

Erectile dysfunction and hypertension.

Recent analyses suggest that about 67-68% of men with hypertension have some degree of erectile dysfunction (ED). With about 25 million men in the US with hypertension, substantial numbers of hypertension-related ED exist that tend to be of a more severe nature than the general population. Men with ED are also more likely to have hypertension. Thiazide diuretic and beta-blocker therapy may contribute to ED. Phosphodiesterase-5 (PDE5) inhibitors are effective therapy in men with ED owing to hypertension who are taking antihypertensive medicines including those on multiple antihypertensive medicines. The addition of PDE5 inhibitors to usual common antihypertensive medicines (diuretics, beta blockers, calcium blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers) results in either no or small additive reductions in blood pressure (BP) and no increase in serious clinical adverse events. There are however precautions regarding the use of PDE5 inhibitors in patients taking alpha blockers for either hypertension or benign prostatic hypertrophy, as some patients may develop orthostatic hypotension. Organic nitrates remain an absolute contraindication for PDE5 inhibitors because synergistic and symptomatic reductions in BP may occur in some patients with this drug combination.

Antihypertensive Agents↗

PubMed2006

The evolutionary role of erectile dysfunction.

Biologic processes that affect the ability of an organism to reproduce are subject to heavy evolutionary pressure. Erectile dysfunction (ED), a common condition in elderly males, definitely affects the ability of the organism to reproduce, and therefore, it is expected to play a significant evolutionary role. Whereas oogenesis is limited to young females, spermatogenesis is a lifelong process. As a male gets older, the number of (pre-meiotic) mitotic cell divisions during spermatogenesis increases, as does the risk of de novo gene mutations. In this paper, I examine the hypothesis that ED, in addition to decrease in fertility, are two evolutionary safety mechanisms that reduce the probability of an ovum being fertilized with genetically altered sperm from an aged or sick male. This hypothesis is supported by the parallel rise in the occurrence of ED, infertility, and risk of congenital anomalies with age; by the occurrence of these three processes in the same medical conditions; and by the presence of a theory unifying the etiologies of three processes-the "free radical theory of aging". This hypothesis can predict the occurrence of congenital anomalies under conditions associated with ED and infertility but are presently not known to be associated with congenital anomalies.

Aged↗

PubMedDate not supplied

Beliefs about illness and quality of life among men with erectile dysfunction.

The objective of the study was to apply an illness representations framework to examine patients' beliefs about erectile dysfunction (ED) and the association between those beliefs and reported quality of life. A total of 41 patients attending two secondary care clinics at a teaching hospital completed questionnaires examining quality of life, sexual functioning, illness representations (cause, time-line, coherence, consequences, cure, control and emotion) and perceptions of masculinity. Masculinity, sexual function, emotions and beliefs about consequences were found to be significantly correlated with quality of life. Multiple regression analysis revealed a model that accounted for almost 35% of the variance in quality of life of ED patients. The strongest predictor of higher quality of life was better sexual functioning (beta = -0.342, P < 0.05) followed by more positive beliefs about the effects of ED on masculinity (beta = 0.323, P < 0.05). The results suggest that when assessing the quality of life of men with ED, patients' illness representations should be considered along with their level of sexual functioning and the effects of ED on masculinity. Patients may benefit from an intervention programme that includes an educational component, thereby providing patients with more information about treatment options and available support.

Adult↗

PubMed2001

Sildenafil test: changes in the diagnostic and therapeutic management of erectile dysfunction.

OBJECTIVE: To assess the efficacy of sildenafil as a first-step diagnostic and therapeutic tool for erectile dysfunction (ED) and to evaluate the consequent changes in the management of male sexual insufficiency. MATERIALS AND METHODS: Sildenafil in titrating doses up to 100 mg was prescribed to 50 men presenting to a sexual dysfunction clinic with medically documented ED. They had not undergone any specific diagnostic test before starting sildenafil. RESULTS: Of the 50 men, 24 (48%) responded to sildenafil. Of these, 8 (33.3%) responded to 50 mg and 16 (66.7%) to 100 mg of sildenafil. Of the responders, 9 representing 18% of all studied men were discharged achieving spontaneous erections in a mean follow-up of 5.3 months. Men with no medical history, men with hypertension and men with mild coronary artery disease responded better. CONCLUSIONS: The sildenafil test revealed that 48% of men responded to this therapy with no requirement for more invasive tests and that 18% of men required no further treatment at all. In addition this test reduced the overall cost of the diagnostic investigation. It is proposed that the sildenafil test should be used in cases with no significant medical history or in men with hypertension or mild coronary artery disease although almost all men with ED could be categorized as sildenafil-responders or sildenafil-resistant. It is also suggested that the sildenafil test would result in the ability for more men with ED to be managed exclusively in the primary care sector.

Erectile Dysfunction↗

PubMed2003

Prevalence and severity of erectile dysfunction in 50 to 75-year-old Finnish men.

PURPOSE: We estimated the prevalence and severity of erectile dysfunction (ED) in a population based sample of 50 to 75-year-old Finnish men. MATERIALS AND METHODS: The target population consisted of all noninstitutionalized men 50, 60 or 70 years old residing in the study area in 1994. Questionnaires were mailed to 3,143 men in 1994 and to 2,864 men 5 years later. ED was assessed by 2 questions on subject ability to achieve and maintain erection sufficient for intercourse. Subjects were classified for analysis into none, minimal, moderate and complete ED groups. RESULTS: The overall prevalence of ED was 76.5%. The prevalence of ED increased from 67% for men 50 years old to 89% for those 75 years old. The prevalence of moderate and complete ED was 29%, increasing rapidly with age from 12% for age 50 years to 58% at age 75 years. Moderate ED increased by 8%, whereas complete ED increased by 18% for each 1-year age increment. CONCLUSIONS: ED is a highly prevalent disorder in 50 to 75-year-old men. It increases with age and is markedly higher after age 60 years. The prevalence of moderate ED increases linearly and slowly, while that of complete ED increases exponentially and rapidly with advancing age.

Age Factors↗

PubMed2002

Quality control in the screening of erectile dysfunction--results of a survey.

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

Adult↗

PubMed1999

Erectile dysfunction in the aging man.

There has been and continues to be a revolution in the treatment available for erectile dysfunction, a disorder that affects quality of life and sense of self-esteem. It should be considered mandatory to assess and discuss this problem in all older men.

Aged↗

PubMed2005

Peyronie's disease in diabetic patients being screened for erectile dysfunction.

PURPOSE: We assessed the prevalence of Peyronie's disease (PD) in type 2 diabetic patients who were screened for erectile dysfunction (ED). MATERIALS AND METHODS: A total of 1,133 male diabetic Saudi patients were enrolled in this study. Patients were screened for ED using the International Index for Erectile Function. At the screening time, all patients were also interviewed for sociodemographic data and risk factors for ED and diabetes that included age, obesity, smoking, hypertension, dyslipidemia, ischemic heart disease and psychological disorders. Medical history included diabetes, duration of diabetes and diabetes related complications. The diagnosis of Peyronie's disease was based on a palpable penile plaque or acquired penile curvature. RESULTS: Mean age +/- SD for the study sample was 53.9 +/- 10.8 years. Of the patients, 8.1% were diagnosed as having PD. Penile plaque and curvature were the most common findings. About 75% of the patients had long duration and progressive course of their complaint. Significant associations between PD and both ED and longer duration ED were detected. There were also significant associations between PD and age, obesity, smoking, duration and number of cigarettes smoked per day. Dyslipidemia, psychological disorders and presence of at least 1 risk factor were significantly associated with PD. There were significant associations between longer duration and poor metabolic control of diabetes and PD. CONCLUSIONS: Peyronie's disease was prevalent among diabetic patients being screened for ED. The study offered a quantitative estimate of the prevalence of PD, and investigated the association of main risk factors and comorbidities of diabetes and ED with PD.

Adult↗

PubMed2002

Cigarette smoking as risk factor for erectile dysfunction: results from an Italian epidemiological study.

OBJECTIVES: We analysed the role of smoking on the risk of erectile dysfunction (ED) using data from a cross-sectional study on prevalence and risk factors for ED in the general population in Italy. METHODS: A total of 2010 men aged more than 18 years were randomly identified and interviewed by 143 general practitioners among their registered patients. Patients were asked "about their ability to achieve and maintain an erection sufficient for satisfactory sexual performance." If they were dissatisfied, they were defined as having ED. RESULTS: In comparison with never smokers, current smokers had an odds ratio (OR) of ED of 1.7 (95% confidence interval (CI), 1.2-2.4) and ex-smokers of 1.6 (95% CI, 1.1-2.3). The association between smoking and ED risk was present in subjects without a history of any cardiovascular disease, cardiopathy, hypertension, diabetes and neuropathy, but not in those with a history of these conditions. For example, the ORs of ED in smokers, in comparison with never smokers, were respectively 2.4, 2.0 and 1.7 in men with no history of any cardiovascular disease, diabetes and neuropathy, but respectively 1.0, 1.0 and 1.2 in those with a history of the conditions. CONCLUSIONS: This study shows that the risk of ED is influenced by smoking and that the duration of the habit increases the risk. Further, it highlights the potential interaction of smoking with medical history on ED risk.

Aged↗

PubMed2005

A study of the management of erectile dysfunction in general practice.

BACKGROUND AND OBJECTIVES: The Department of Health issued guidelines for the NHS treatment of erectile dysfunction (ED) with phosphodiesterase type 5 inhibitors (PDE 5 inhibitors) in 1999. There has been an increasing trend in the prescribing of PDE 5 inhibitors within Bebington and West Wirral Primary Care Trust (PCT) over the 3-year period from February 2001 to January 2004. The objective of the study was to investigate implementation of Government guidelines on prescribing of PDE 5 inhibitors for ED and the cost of prescribing outside these guidelines. METHODS: Practice data were collected for all patients prescribed a PDE 5 inhibitor in 16 surgeries within Bebington and West Wirral Primary Care Trust, from November 2002 to December 2003. The data were evaluated with respect to adherence to UK Government guidelines. Analysis was made on the cost to the PCT with respect to treatment provided outside the guidelines. RESULTS AND DISCUSSION: Prescribing for 78% of patients was within Government guidelines. With respect to frequency of prescribing, 89% of patients in the PCT received less than or equal to the recommended frequency of one tablet per week. The percentage range for practices was 67-100%. The cost to the PCT for PDE 5 inhibitor treatment provided outside the guidelines was 19,060 pounds sterling over the period of study. CONCLUSION: Prescribers generally follow Government guidelines, however, stricter adherence to guidelines could result in more efficient use of National Health Service resources.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1998

Vasoactive cocktails for erectile dysfunction: chemical stability of PGE1, papaverine and phentolamine.

PURPOSE: Vasoactive cocktails are widely used in diagnosing and treating erectile dysfunction, especially in poor responders to prostaglandin E1 (PGE1). However, very little information as to their chemical interactions and stability is available, despite the huge amount of published work regarding their clinical efficacy. Obviously, medical and legal problems are involved. MATERIALS AND METHODS: We analyzed four kinds of vasoactive cocktails, composed of papaverine, phentolamine and PGE1 in different combinations, using High Performance Liquid Chromatography analysis after 5 to 60 days of storage at temperatures between 2 and 8C. SPSS MANOVA analysis and a t-test for paired samples were used for statistical purposes. RESULTS: Papaverine and phentolamine concentrations showed no significant variations during the 2 month study, ranging from a minimum of 96.75+/-1.20 to a maximum of 103.00+/-0.20% of the starting values. In the same period, PGE1 showed an accelerated degradation profile, reaching concentration values, after 60 days, of 76.00+/-2.28% and 70.20+/-2.02% when added to phentolamine or papaverine respectively and 70.00+/-2.40% with both. CONCLUSIONS: Papaverine and phentolamine are characterized by chemical stability when blended together or with PGE1. Papaverine and/or phentolamine increase the naturally occurring degradation of PGE1 in physiological solution. This effect is most evident in the first 10 days. Papaverine has the greatest deteriorating effect on PGE1. A safe and proper use of these cocktails should take into account the variations of PGE1 concentration.

Adrenergic alpha-Antagonists↗

PubMed2003

Prevalence and risk factors for erectile dysfunction in a population-based study in Iran.

To explore the prevalence of and risk factors for erectile dysfunction (ED) in Iran. A total of 2674 men aged 20-70 y old were interviewed by 42 general practitioners and answered a self-administered questionnaire. The subjects were randomly identified from 28 counties of Iran. ED was defined as difficulties in achieving an erection before sexual intercourse and maintaining it. Data on medical history, toxic habits, and current use of medications were also obtained. Of the men interviewed, 18.8% (460) reported ED. Impotence was found to be significantly associated with age and was less associated with geographical location. The prevalence increased with age, from 6% in men 20-39 y to 47% in those >60 y (tested for trend < or = 0.001). A history of diabetes (odds ratio (OR) 3.72, 95% confidence interval (CI), 2.51-5.71), hypertension (OR 1.69, 95% CI, 1.31-2.40), peripheral vascular disorders (OR 2.44, 95% CI, 1.65-3.74), hypercholesterolemia (OR 1.71, 95% CI, 1.11-2.65), and coronary artery disease (OR 1.61, 95% CI, 1.21-2.85) were significantly associated with ED. In comparison with never smokers, the OR of ED was 2.41 (95% CI, 1.52-3.30) for current smokers and 2.15 (95% CI, 1.38-3.1) for ex-smokers and increased with duration of the habit. Drug intake, called tranquilizers and antidepressants, correlated strongly (OR 3.71, 95% CI, 2.51-6.76 and OR 2.80, 95% CI, 1.47-4.32, respectively). This study provides a quantitative estimate of the prevalence and main risk factors for ED in Iranian men.

Adult↗

PubMed2005

Association between the bothersomeness of lower urinary tract symptoms and the prevalence of erectile dysfunction.

OBJECTIVE: To assess the association between the bothersomeness of lower urinary tract symptoms (LUTS) and the prevalence of erectile dysfunction (ED). METHODS: The target population comprised all men born in 1924, 1934, or 1944 and residing in Tampere or 11 surrounding municipalities in Finland in 1999. A questionnaire was sent in May 1999 to 2,864 men, and 2,133 (75%) responded. Of them, 417 were excluded because of missing data on erectile function, or because they had prostate cancer or radical prostatectomy, leaving a total of 1,716 (60%) qualified respondents. LUTS was assessed by the Danish Prostatic Symptom Score, and ED by a short form of the International Index of Erectile Function. Logistic regression model was used in the multivariate analysis. RESULTS: Adjusted odds ratios (ORs) of ED were 2.6 (95% CI 1.3-5.2) for men with LUTS total scores of 11-19 compared with men without LUTS and were not bothered by them, and 4.4 (2.1-8.9) for those with scores 20 or more. Bother scores 1-3 and 4-6 were significantly associated with ED (OR 1.8, 95% CI 1.2-2.6 and 2.1, 1.4-3.4, respectively), while similar symptoms scores were not. Adjusted ORs of ED was 4.1 (2.0-8.2) for men with a symptoms score of 10 or more compared with those free from symptoms, and same (OR 4.2, 95% CI 2.7-6.7) for men with similar bother score. Among symptoms, nocturia (adjusted OR 1.5), weak stream (OR 1.5), stress incontinence (OR 2.1), and overflow incontinence (OR 1.8) were significantly associated with ED, whereas among bother, only overflow incontinence (OR 2.2) was significantly correlated with ED. CONCLUSIONS: ED is a common problem in men with LUTS and is strongly associated with both the severity of symptoms and their bothersomeness. However, bother of mild LUTS affects ED more than the mild symptoms, emphasizing the potential of psychological mechanisms of ED.

Aged↗

PubMed2004

Expression of cavernous transforming growth factor-beta1 and its type II receptor in patients with erectile dysfunction.

It has been hypothesized that transforming growth factor-beta1 (TGF-beta1) signalling is involved in erectile dysfunction (ED). This study was undertaken to elucidate in detail whether expression of TGF-beta1 and its type II receptor is clinically related to various causes of ED. Fifty-four patients with ED and 24 potent men were the subjects of this study. After multidisciplinary work-up, the ED was classified as psychogenic (n = 6), neurogenic (n = 15), or vasculogenic (n = 33). In every subject, percutaneous cavernous biopsy was performed using a Biopty gun. Masson's trichrome staining was used to quantitate collagen fibres and immunohistochemical staining to evaluate both TGF-beta1 and its type II receptor by scoring the intensity of immunoreactivity (score 0-6). Collagen fibres were significantly more abundant in men with vasculogenic ED (72.7 +/- 17.7%) than in control subjects (43.3 +/- 11.2%) or those with psychogenic (45.0 +/- 12.2%) or neurogenic (51.3 +/- 20.3%) ED (p < 0.01). Expression of TGF-beta1 was significantly greater in vasculogenic ED (4.3 +/- 1.3) than in the control subjects (2.4 +/- 0.9) or psychogenic ED (2.0 +/- 0.6) groups (p < 0.01). Type II receptor expression was also significantly increased in vasculogenic ED (3.9 +/- 1.3) compared with control (2.2 +/- 0.7) and psychogenic (2.2 +/- 0.8) or neurogenic (2.6 +/- 1.3) ED (p < 0.01). Of the ED groups, both the hyperlipidaemia and the atherosclerosis patients showed significantly more fibrosis than those without the condition (p < 0.05). The abundance of collagen fibres correlated well with both TGF-beta1 expression (gamma = 0.81; p < 0.001) and receptor II expression (gamma = 0.83; p < 0.001). These results suggest that TGF-beta1 and its receptor II pathway are involved in cavernous fibrosis and ED in man. Patients with vascular risk factors such as hyperlipidaemia and atherosclerosis are liable to ED by activation of this pathway.

Adult↗

PubMed2004

Erectile dysfunction in hypertensive rats results from impairment of the relaxation evoked by neurogenic carbon monoxide and nitric oxide.

Erectile dysfunction (ED) with aging and diabetes mellitus is caused by impairment of the relaxation evoked by nitric oxide (NO) of penile cavernous smooth muscles and arterioles. However, the mechanism of ED in hypertension is unknown. Carbon monoxide (CO), which is produced by heme oxygenase (HO)-2 in the neuronal system is a neurotransmitter and a vasodilator. We examined the neurogenic role of CO in penile erection and the neurogenic mechanisms of ED in hypertension, using spontaneously hypertensive rats (SHR) or Wistar-Kyoto rats (WKY). The isometric tension of corpus cavernosum tissues from both strains was recorded after guanethidine and atropine treatment. Relaxation in response to electrical field stimulation (EFS) in WKY was suppressed dose-dependently by HO inhibitors both in the absence and presence of an NO synthase (NOS) inhibitor. Reverse transcription-polymerase chain reaction (RT-PCR) showed that the HO-2 gene was expressed in the corpus cavernosum. CO-saturated solution induced a concentration-dependent relaxation in WKY. The neurogenic relaxation to EFS in SHR was impaired as compared with that in WKY after the age of 5 weeks, when blood pressure began to be elevated, due to the attenuated relaxation in response to neurogenic NO and CO. In the corpus cavernosum of SHR, expression of the HO-2 and nNOS genes was similar, and NOx levels after EFS were similar to those of WKY. cGMP levels after EFS and the relaxation evoked by the NO donor was lower in SHR than WKY. Thiobarbituric acid-reacting substance (TBARS) levels were increased, and superoxide dismutase (SOD) activity was suppressed in SHR, as compared with those in WKY, suggesting that the increasing oxidative stress partially causes the impairment of NO-dependent relaxation. These findings suggest that CO regulates the relaxation evoked by EFS in the rat corpus cavernosum, and that ED in hypertension in rats results from an impairment of the relaxation induced by neurogenic CO and NO.

Animals↗