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PubMed2004

Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction.

We studied the psychological and biological correlates of hypoactive sexual desire (HSD) in a consecutive series of 428 patients with erectile dysfunction (ED), by using the structured interview SIEDY. A complete physical examination and a series of biochemical, hormonal, psychometric, and penile vascular tests were also performed. Among the patients studied, 22.8% reported a mild, 12.9% a moderate, and 4.6% a complete loss of sexual interest. Patients reporting HSD showed significantly lower testosterone (T) levels than the rest of the sample, although the prevalence of hypogonadism (T<10 nM) was comparable in the two groups. Only a minority (<2%) had severe hyperprolactinemia (>700 mU/l), which, nonetheless, was closely associated with a relevant HSD. Both mental disorders and use of medication interfering with sexual function were significantly associated with HSD, as well as depressive and anxiety symptoms. HSD patients showed significantly higher scores in SIEDY scale 2, which explores the relational component of ED. In particular, perceived partner's libido and climax were crucially associated with an impairment of patients' sexual desire. In conclusion, HSD in ED is associated with several biological, psychological, and relational factors that can be simultaneously identified and quantified using the SIEDY structured interview.

Adult↗

PubMedDate not supplied

Hormone levels in middle-aged and elderly men with and without erectile dysfunction in Taiwan.

The change in sexual hormones with age in middle-aged and elderly Chinese men, with and without erectile dysfunction (ED), was investigated. Total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS), and sex hormone-binding globulin (SHBG) were determined from fasting serum samples by radioimmunoassay in 627 middle-aged and elderly ethnic Chinese men with and without ED. Calculated FT was derived from TT and SHBG. Patients with ED were subdivided into groups having low serum TT (<2.7 ng/ml) and normal TT (> or =2.7 ng/ml). FT and DHEAS declined and SHBG rose with age in both normal patients and in patients with ED. TT and SHBG were lower in patients with ED than in normal subjects at all ages. In contrast to findings in previous studies, levels of FT were higher in patients with ED than in normal subjects. Hormonal changes in this Chinese population generally mirrored those in previously studied ethnic populations, except for higher FT in patients with ED. This suggests that hormonal levels in patients with ED may vary in different populations. The significance and reproducibility of this finding remains to be determined.

Adult↗

PubMed1999

The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences.

OBJECTIVES: To project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health-policy consequences using the recent developments in the UK as a case study. METHODS: Using the United Nations projected male population distributions by quinquennial age groups for 2025, the prevalence rates for ED were applied from the Massachusetts Male Aging Study (MMAS) to calculate the likely incidence of ED. The MMAS has the advantage of being the first study to provide population-based rates rather than rates based on clinical samples. All the projections were age-adjusted. RESULTS: It is estimated that in 1995 there were over 152 million men worldwide who experienced ED; the projections for 2025 show a prevalence of approximately 322 million with ED, an increase of nearly 170 million men. The largest projected increases were in the developing world, i.e. Africa, Asia and South America. DISCUSSION: The likely worldwide increase in the prevalence of ED (associated with rapidly ageing populations) combined with newly available and highly publicized medical treatments, will raise challenging policy issues in nearly all countries. Already under-funded national health systems will be confronted with unanticipated resource requests and challenges to existing government funding priorities. The projected trends represent a serious challenge for healthcare policy makers to develop and implement policies to prevent or alleviate ED.

Age Distribution↗

PubMed2006

Are age, anthropometry and components of metabolic syndrome-risk factors interrelated with lower urinary tract symptoms in patients with erectile dysfunction? A prospective study.

AIM: To evaluate the effects of metabolic profiles on lower urinary tract symptoms (LUTS) in men with erectile dysfunction (ED). METHODS: A total of 75 impotent men aged 25-75 years old (mean 58.1 years) were included in the study on a prospective basis. Patients were evaluated with a complete history, physical examination, anthropometry and metabolic profiles. LUTS were assessed using the International Prostate Symptom Score (IPSS). RESULTS: Overall, there was no correlation between the IPSS and continuous parameters. However, when continuous variables were categorized, some parameters were significantly associated with LUTS. Patients with triglyceride level of 150 mg/dL or higher had more severe symptoms than those with triglyceride levels less than 150 mg/dL (19.4 +/- 2.4 vs. 14.3 +/- 1.1, P = 0.033). When 40 mg/dL was chosen as the high-density lipoprotein (HDL)-cholesterol cut-off level, the IPSS was significantly different between the two groups divided by 40 mg/dL (19.4 +/- 2.6 for HDL-cholesterol < 40 mg/dL vs. 14.4 +/- 1.0 for HDL-cholesterol = or > 40 mg/dL, P = 0.042). The area under the receiver operating characteristic curve (AUROCC) of triglyceride was 65.7% (95% confidence interval [CI], 52.6%-82.3%; P = 0.034) for severe LUTS. However, the AUROCC for 'HDL-cholesterol' was not significant (area, 65.4%; 95% CI, 48.2%-82.7%; P = 0.062). No other factors were determined to be significant in this regard. CONCLUSION: The results of the present study indicate that some metabolic profiles might influence LUTS in men with ED.

Adult↗

PubMed2003

Prevalence of erectile dysfunction and associated factors among men without concomitant diseases: a population study.

We interviewed a population sample of 2412 men aged 40-70 y in Brazil, Italy, Japan and Malaysia about medical history, lifestyle habits and sexual behavior. Men were classified as having moderate or complete erectile dysfunction (ED) if they reported to be sometimes or never able to achieve and maintain an erection satisfactory for sexual intercourse, respectively. There were 1335 men with no diagnosis of cardiovascular or prostate diseases, diabetes, ulcer or depression, nor taking hormones. The prevalence of ED was 16.1%. ED was associated with age (the risk increased 8% per y), moderate (odds ratio (OR)=2.2) or severe (OR=4.9) lower urinary tract symptoms and smoking (OR=2.3 for >30 cigarettes/day). It was inversely associated with physical activity (OR=0.5) and higher educational levels. Between the ages of 40 and 70 y, almost one in six 'healthy' men is affected by ED. Further research should look at preclinical disease stages and genetic factors.

Adult↗

PubMed2004

Obstructive lower urinary tract symptoms correlate with erectile dysfunction.

OBJECTIVES: To examine whether the severity of lower urinary tract symptoms (LUTS), when controlled for other factors, is related to erectile dysfunction (ED) in the male veteran population. Early evidence suggests that LUTS may be associated with ED in men. METHODS: A total of 181 male veterans were prospectively entered into the study. They completed the Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score (IPSS) questionnaires. Of the 181 men, 144 also underwent uroflowmetry, including determination of the postvoid residual urine volume. Demographic and medical history data were recorded. Pearson correlation coefficients and multiple linear regression analysis were used to examine the relationship between LUTS and ED, as well as the effects of age and comorbidities. RESULTS: The correlation coefficient (r) for the SHIM score with the total IPSS was -0.17 (P = 0.023); with the obstructive IPSS, it was -0.20 (P = 0.006); and with the irritative IPSS, -0.05 (P = 0.492). Age was the only other factor with a statistically significant correlation with the SHIM score (r = -0.23, P = 0.002). Multiple linear regression modeling showed obstructive IPSS (P = 0.001) and depression (P = 0.017) to be the only statistically significant predictors of the SHIM score. A consistent negative correlation was found between obstructive IPSS and the SHIM score across age groups, with the strongest effect for men aged 60 to 70 years (r = -0.412, P = 0.003). CONCLUSIONS: Obstructive LUTS correlated with, and were predictive of, ED, even after controlling for age and comorbidities. Although age correlated with ED, it did not add to the power of the multiple linear regression model composed of obstructive IPSS and depression.

Adult↗

PubMed2006

Erectile dysfunctions in patient-physician communication: optimized strategies for addressing sexual issues and the benefit of using a patient questionnaire.

INTRODUCTION: Erectile dysfunctions are prevalent but underdiagnosed and undertreated health problems. Communication barriers between patients and physicians are one of the main reasons for this and responsible for a low report rate of sexual dysfunction. AIM: The main aim of the study was to investigate which phrasing and communication strategies gained the highest acceptance from physicians and their patients and were considered the most effective. MAIN OUTCOME MEASURES: A documentation form on which each consultation was rated by the participating physicians. METHODS: A large group of physicians was asked to hand out a short patient questionnaire to all male patients over 30 years. The physician was instructed to discuss the questionnaire with the patient and to ask him about sexual problems. A total of 1,191 physicians took part in the study that documented a total of 10,622 consultations with an average duration of 15 minutes. RESULTS: The main results were: (i) the patient questionnaire found a high level of acceptance and 54% of discussions of sexual health were prompted by it; (ii) the patients' reaction to physicians addressing sexual health was positive in more than two-thirds of the sample and characterized by openness, willingness to communicate, and relief that their sexual problems had been addressed; (iii) from the physicians' perspective, the most favored communication strategies were a clear signaling of a willingness to talk, and addressing treatment possibilities or signaling that help was available; and (iv) the resulting discussion led to further diagnostic measures in 25% of patients and to further therapeutic measures in 60% of patients. CONCLUSIONS: There are good grounds for concluding that: (i) addressing a patient's sexual health as part of a physician's everyday routine is feasible in terms of duration and content; and (ii) a short patient questionnaire is an excellent aid for patients and physicians for initiating communication on the topic.

Adult↗

PubMed1999

The use of acupuncture in the treatment of erectile dysfunction.

The efficacy of acupuncture as a mono-therapy was evaluated in a pilot study of 16 patients suffering from erectile dysfunction (ED). In nine patients no organic co-morbidity was encountered. In a period of four weeks, acupuncture treatment was performed twice a week for a total of eight sessions. Each treatment session consisted of puncture of the same eight acupoints, four of which were connected to a Swiss made constant current Doltron ESA 600 stimulator. Low frequency electrical stimulation (5 Hz and 10 mA) was applied to these four acupoints, whereas no stimulation was applied to the other four points. After 30min, the electrical stimulation was terminated and all needles removed. Blood samples were drawn according to a fixed time schedule, to study the profile of a number of stress hormones, for example, adrenocorticotropic hormone, antidiuretic hormone and cortisol, the gonadotrophines follicle stimulating hormone and leutinizing hormone, and the sex steroid testosterone and its binding globulin, within the treatment period. Based on a diary of both patient and partner, and an interview one month after the end of treatment, the changes of sexual activity were evaluated over a period of 12 weeks, starting from the four weeks prior to the treatment, the four weeks during the treatment period and the four weeks after the treatment. An improvement of the quality of erection was experienced by 15% of patients, while 31% reported an increase in their sexual activity. No changes in the profiles of hormones were detected. The use of acupuncture as a mono-therapeutic modality in ED, did not influence the profile of the stress and sex hormones, but did improve the quality of erection and restored the sexual activity with an overall effect of 39%. No definite conclusions can be drawn from this pilot study. A controlled and blinded study including more patients will be needed before any definitive conclusion can be reached.

Acupuncture Therapy↗

PubMed2003

Trazodone for erectile dysfunction: a systematic review and meta-analysis.

OBJECTIVE: To determine the efficacy and safety of trazodone in the treatment of erectile dysfunction (ED) in a meta-analysis. METHODS: The data sources used were Medline and the Cochrane Library databases (January 1966 to May 2002), bibliographies of retrieved articles and review articles, and conference proceedings and abstracts. Trials were eligible for inclusion in the review if they included men with ED, compared trazodone with a control, were randomized, of > or = 7 days' duration and assessed clinically relevant outcomes. Two reviewers independently evaluated study quality and extracted data in a standardized fashion. RESULTS: Six trials (comprising 396 men) met the inclusion criteria; they consisted of heterogeneous populations, were small, brief and in some cases methodologically weak. Three of the six trials showed an apparently clinically meaningful benefit of trazodone for ED compared with placebo, the differences being statistically significant in two. In pooled results, trazodone monotherapy appeared more likely than placebo to lead to a 'positive treatment response', although this difference was not statistically significant (37% vs 20%; relative benefit increase, 1.6; 95% confidence interval, CI, 0.8-3.3). Subgroup analyses suggested that men with psychogenic ED might be more likely to benefit from trazodone than those with mixed or physiological ED. The efficacy of trazodone also appeared greater at higher doses (150-200 vs 50 mg/day). Men randomized to trazodone were not significantly more likely than those receiving placebo to withdraw for any reason or for an adverse event, or to have specific adverse events, but wide CIs could not exclude a greater risk of these adverse outcomes with trazodone. Specific adverse events with trazodone included dry mouth (19%), sedation (16%), dizziness (16%) and fatigue (15%). CONCLUSION: Trazodone may be helpful in men with ED, possibly more so at higher doses, and in men with psychogenic ED. Future high-quality trials should compare trazodone with placebo and other therapies in men with depression and psychogenic ED.

Adult↗

PubMed2005

Sexual intercourse attempt patterns with two dosing regimens of tadalafil in men with erectile dysfunction: results from the SURE study in 14 European countries.

OBJECTIVE: To describe the pattern of sexual attempts by men with erectile dysfunction (ED) taking tadalafil 20 mg on demand or on an alternative dosing regimen, 3 times/week, and to assess changes in sexual behavior when the patients were exposed to the alternative regimen. DESIGN AND METHODS: Scheduled use versus on-demand regimen evaluation (SURE) is a multicenter, crossover, open-label study conducted in 14 European countries. Men with ED (N = 4,262) were randomized to tadalafil 20 mg on-demand treatment (maximum one dose per day and before sexual activity) or 3 times/week for 5-6 weeks. After a 1-week washout period, patients were crossed over to the alternative regimen for 5-6 weeks. RESULTS: Nearly half (47%) of the attempts on the on-demand regimen and 71% of the attempts on the 3 times/week treatment were performed by patients more than 4 hours post dosing. Sexual activity occurred throughout the week on both regimens, with the highest percentage of attempts made during the weekend (50% on on-demand and 48% on 3 times/week) and evening and morning hours. The efficacy of tadalafil was more than 70% mean-per-patient success rate (Sexual Encounter Profile question 3) regardless of the time interval post dosing. CONCLUSIONS: Patients on tadalafil changed their sexual behavior significantly when on an alternative dosing regimen (3 times/week) and had sexual attempts distributed over a wide period of time post dosing. A substantial number of sexual attempts were performed beyond the first 4 hours post dosing on both regimens (47% for on-demand and 71% for 3 times/week) and preferably in the evening and morning hours. Tadalafil was efficacious regardless of the time interval post dosing-i.e., up to 36 hours. The two treatment regimens, on-demand and 3 times/week, provide an additional option and unique flexibility in dosing for men with ED and their partners.

Carbolines↗

PubMed2001

Cavernous and systemic testosterone plasma levels during different penile conditions in healthy males and patients with erectile dysfunction.

OBJECTIVES: To determine the testosterone plasma levels in the cavernous and peripheral blood taken during different penile conditions from patients with erectile dysfunction (ED) and to evaluate whether these courses are different from those detected in the blood of healthy males. Although the determination of the systemic testosterone concentration (TC) has been fairly well established in the diagnostic workup of ED, the exact role of testosterone in adult male sexual function remains unclear. METHODS: Blood samples were drawn simultaneously from the corpus cavernosum and cubital vein of 54 healthy males with normal erectile function and 46 patients with ED during the penile stages of flaccidity, tumescence, rigidity (reached by the healthy males only), and detumescence. Tumescence and rigidity were induced by audiovisual and tactile stimulation. The TC was determined by means of a radioimmunoassay. RESULTS: In the flaccid phase, the TC in the cavernous blood taken from the healthy volunteers was 2.9 +/- 1.2 ng/mL. The TC significantly increased during tumescence (4.3 +/- 1.3 ng/mL) and rigidity (4.4 +/- 1.4 ng/mL), P <0.001. In the detumescence phase, the TC decreased appreciably to 3.5 +/- 1.4 ng/mL. In the systemic blood, the increase from flaccidity (4.1 +/- 1.1 ng/mL) to tumescence (4.4 +/- 1.4 ng/mL) was found to be less pronounced but, nevertheless, significant (P = 0.001). No further increase was detected during rigidity. From rigidity to detumescence, the systemic TC dropped to 4.1 +/- 1.2 ng/mL. In the patients with ED, the mean increase in systemic and cavernous testosterone levels from flaccidity (cubital vein 3.0 +/- 1.0 ng/mL, corpus cavernosum 2.6 +/- 1.0 ng/mL) to tumescence (cubital vein 3.2 +/- 1.1 ng/mL, corpus cavernosum 3.0 +/- 1.0 ng/mL) was less pronounced. Nevertheless, the course of testosterone detected in the systemic and cavernous plasma of the patients during flaccidity, tumescence, and detumescence resembled that registered in the healthy controls. In the flaccid phase, the mean cavernous TC in the healthy subjects was found to be 30% lower than the level in the peripheral blood; in the patients with ED, this difference was only 13%. CONCLUSIONS: In the healthy males, the penile erection was accompanied by an increase in the cavernous and peripheral TC. The difference between the peripheral and cavernous TC in the healthy subjects and patients with ED in the flaccid phase, when the blood flow through the cavernous body is minimized, might be a diagnostic tool to evaluate the amount of bioavailable testosterone, as well as the density of testosterone receptors, in the cavernous smooth musculature.

Erectile Dysfunction↗

PubMed2001

A comparison of radiation dose to the bulb of the penis in men with and without prostate brachytherapy-induced erectile dysfunction.

PURPOSE: To retrospectively evaluate the relationship between the radiation dose to the bulb of the penis and the development of erectile dysfunction (ED) in patients undergoing permanent prostate brachytherapy without external beam radiation therapy. METHODS AND MATERIALS: Twenty-three men who developed ED after transperineal ultrasound-guided permanent prostate brachytherapy for clinical T1/T2 adenocarcinoma of the prostate gland were paired with 23 similar men who maintained potency after implantation. Potency was defined as an erection sufficient for vaginal penetration. The mean and median follow-up for the entire group was 34.6 +/- 13.7 months and 32.8 months, respectively. Patients were implanted with either (125)I (145 Gy TG-43) or (103)Pd (115 Gy, pre-NIST-99). No patient received external beam radiation therapy either before or after brachytherapy. The bulb of the penis was outlined at 0.5-cm intervals on the Day 0 postimplant CT scan. The radiation dose distribution to the bulb of the penis was defined in terms of the minimal dose delivered to 25%, 50%, 70%, 75%, 90%, and 95% of the bulb (D(25), D(50), D(70), D(75), D(90), and D(95)). RESULTS: The radiation dose delivered to the bulb of the penis in men with postbrachytherapy-induced ED was statistically greater for all evaluated dosimetric parameters (D(25), D(50), D(70), D(75), D(90), and D(95)). Multivariate analysis indicated that dose to the bulb of the penis and patient age at the time of implant were predictive of postimplant ED, whereas choice of isotope had no effect. Among potent patients, 19/23 had D(50) < or = 40% of prescribed minimal peripheral dose, whereas for the impotent patients, 19/23 had D(50) >40% of the minimal peripheral dose. Of the impotent patients, 17 utilized sildenafil, with 15 experiencing a favorable response (88%). CONCLUSION: Our data suggest that prostate brachytherapy-induced impotence is highly correlated with the radiation dose delivered to the bulb of the penis. With Day 0 dosimetric evaluation, the radiation dose delivered to 50% of the bulb of the penis should be maintained at 50 Gy or less to maximize post-treatment potency. Fortunately, the majority of the brachytherapy-induced ED population responds favorably to sildenafil.

Adenocarcinoma↗

PubMed2003

Prevalence and risk factors for erectile dysfunction in Austria--analysis of a health screening project.

PURPOSE: The aim of this study was to determine prevalence and risk factors for erectile dysfunction (ED) in men undergoing a health investigation. METHODS: Men aged 30-69 yrs participating in a health screening project in the area of Vienna completed a 11-item questionnaire on ED which was extracted from the international index of erectile function (IIEF). In parallel, all men underwent a detailed health examination including physical assessment, evaluation of various life-style factors and a blood analysis with 14 parameters. RESULTS: Within the total study population (n = 832; 45.3 +/- 9.8 yrs), 8.2% reported no sexual intercourse during the previous four weeks, 5.1% reported moderate/severe ED, 13.1% mild and 73.6% no ED. ED, defined as any problem in maintaining erection until the end of sexual intercourse, increased from 12.5% in those aged 30-39 yrs to 15.3% at 40-49 yrs, 27.4% at 50-59 yrs and 45.2% in men 60-69 yrs. In parallel, the percentage of men without sexual intercourse during the previous four weeks increased from 7.4% at 30-39 yrs to 8.8% at 50-59 yrs and 17.0% at 60-69 yrs. By far the strongest correlate for ED was age; other factors were cardiovascular diseases, physical activity and diabetes mellitus. CONCLUSIONS: This study provides the first estimate of the prevalence of ED in different life decades of men in Vienna, and identifies a number of risk factors for this highly prevalent disorder in ageing men.

Adult↗

PubMedDate not supplied

Cardiovascular parameter changes in patients with erectile dysfunction using pde-5 inhibitors: a study with sildenafil and vardenafil.

Sildenafil is the most prescribed oral agent for patients with erectile dysfunction (ED). Vardenafil is a new phosphodiesterase type 5 (Pde-5) inhibitor that was approved by the US Food and Drug Administration last year to treat patients with ED of various causes. Both of these Pde-5 inhibitors have vasodilating properties and effects on blood pressure (BP), and like nitrates, they work through the nitric oxide cyclic guanosine monophosphate pathway. The aim of this study was to investigate the influence of these Pde-5 inhibitors on BP and heart rate (HR) in normotensive men with ED by a crossover comparison. Thirty-five patients with ED were enrolled to evaluate and compare the effect of sildenafil (50 mg) and vardenafil (10 mg) on BP and HR. At the screening (baseline [B]) visit, sitting systolic blood pressure (B-SBP), diastolic blood pressure (B-DBP), and HR were measured. We performed a multiple administration for both drugs and, therefore, multiple measurements of BP and HR changes, 3 doses a week, on alternate days, late in the afternoon, and on an empty stomach. B-SBP, B-DBP, and HR were recorded before each 50-mg sildenafil dosing and after 30, 60, 120, and 240 minutes. Data were averaged over the 4 time points and compared with the baseline values obtained before each dosing. After a 3-week wash-out period, patients were crossed over to vardenafil (10 mg) with the same study design. After administration of both drugs, we observed a statistically significant decrease of BP and an increase of HR. On average, sildenafil caused a decrease of SBP ranging from 5.1 +/- 3.9 mm Hg during the first dosing to 4.7 +/- 4.2 mm Hg during the third dosing, DBP ranged from 4.4 +/- 4.9 to 4 +/- 4.1 mm Hg, and HR increased 1.8 +/- 2.0 bpm (first dose) and 1.2 +/- 0.9 bpm (third dose). With vardenafil, we recorded a greater variation for SBP and DBP. SBP decreased from 8.02 +/- 8.0 mm Hg during the first dosing to 5.4 +/- 5.5 mm Hg during the third dosing, whereas DBP decreased from 6.6 +/- 7.2 to 5.0 +/- 5.3 mm Hg, respectively. Recorded HR showed an increase of 3.1 +/- 3.2 bpm (first dose) and 2.4 +/- 2.3 bpm (third dose). After the first vardenafil administration, we recorded fainting episodes in 3 patients because of a decrease in BP greater than 20 mm Hg. Two of the patients were in therapy with doxazosin for benign prostatic hyperplasia (BPH). Cardiovascular response was not significantly different after the first dose between the 2 treatments. Vardenafil demonstrated clinically significant differences (fainting) with respect to sildenafil only during the first doses. We suggest that before starting therapies with Pde-5 inhibitors, particularly with the newer ones, that baseline cardiovascular parameters are measured and monitored, especially during the first dose, because of the presence of a "first dose effect." Moreover, it is necessary to pay particular attention to those patients in treatment with other drugs that could have a synergistic hypotensive effect as a result of vasodilation potentiation.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2000

N-3-substituted imidazoquinazolinones: potent and selective PDE5 inhibitors as potential agents for treatment of erectile dysfunction.

Phosphodiesterase type 5 (PDE5) inhibitors with improved PDE isozyme selectivity relative to sildenafil may result in agents for the treatment of male erectile dysfunction (MED) with a lower incidence of PDE-associated adverse effects. This paper describes the discovery of 14, a PDE5 inhibitor with improved potency and selectivity in vitro compared to sildenafil. This compound shows activity in a functional assay of erectile function comparable to that of sildenafil.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2004

Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes.

PURPOSE: To investigate the efficacy and tolerability of oral propionyl-L-carnitine (PLC) plus sildenafil in men with erectile dysfunction (ED) and diabetes unresponsive to sildenafil monotherapy. MATERIALS AND METHODS: Patients with medically documented ED of organic or mixed aetiology and diabetes (type 1 and 2) were randomised to receive oral PLC (2 g/day) plus sildenafil (50 mg twice weekly) (20 patients, Group 1) or sildenafil alone (20 patients, Group 2), in a double-blind, fixed-dose study. All patients had been previously treated unsuccessfully with a minimum of eight administrations of sildenafil. Efficacy was evaluated using the International Index of Erectile Function (IIEF) questionnaire: total score, subscores for questions 3 (Q3; achieving an erection) and 4 (Q4; maintaining an erection) and global efficacy question (GEQ: 'Has treatment improved your erections?'). Patients Event Logs were also used. RESULTS: After 24 weeks of treatment, mean scores for IIEF Q3 and Q4 had improved significantly in patients of Group 1 (4.25 +/- 0.63 and 3.95 +/- 1.0) compared with Group 2 (2.9 +/- 0.71 and 2.7 +/- 0.96) (p < 0.01). Moreover, the percentage of patients with improved erections (GEQ 68% vs. 23%) and successful intercourse attempts (76% vs. 34%) was significantly increased in Group 1 compared with Group 2 (p < 0.01). Fourteen (70%) patients in Group 1 and four (20%) in Group 2 reported an increase in mean IIEF EF domain score of > or = 4 (p < 0.01). Treatments were well tolerated and no patient discontinued study medication. Two patients in Group 1 reported mild gastric pain. CONCLUSIONS: Salvage therapy with PLC plus sildenafil was more effective than sildenafil in the treatment of ED in patients with diabetes refractory to sildenafil monotherapy.

Carnitine↗

PubMed2001

Successful treatment of erectile dysfunction and infertility by venesection in a patient with primary haemochromatosis.

A 36-year-old patient with primary haemochromatosis presented with erectile dysfunction. Laboratory findings revealed reduced levels of luteinizing hormone (0.4 IU/l; normal range 2-12 IU/l), follicle-stimulating hormone (0.1 IU/l; normal range 1-12 IU/l) and testosterone (0.49 microg/l; normal range 2-8.1 microg/l). We made the diagnosis of secondary hypogonadism due to haemochromatosis, which is generally supposed to be irreversible. Due to consequent venesection therapy, levels of ferritin and transferrin saturation could be normalized, and levels of luteinizing hormone and follicle-stimulating hormone increased to normal ranges. Also, testosterone levels became normal and remained so without any androgen substitution. The patient subsequently regained erectile function and potency. This case underlines the fact that a hypogonadotrophic hypogonadism caused by iron overload can be reversed by a consequent venesection therapy.

Adult↗

PubMed2006

Sexuality and seeking medical help for erectile dysfunction in young adults with spina bifida.

OBJECTIVES: The objectives of this study were to evaluate the correlation between the sexual function of spina bifida (SB) patients and Sharrard classification, touch sensation on the penis, to examine if SB patients who are sexually active have erectile dysfunction (ED) on the International Index of Erectile Function-5 (IIEF5), and to clarify if they seek medical treatment for ED. METHODS: Thirty-six male SB patients aged over 18 years were enrolled. A questionnaire was sent to all patients that included the following items: touch sensation on the penis, psychogenic erection, rigidity at erection, ejaculation, orgasm and experience in sexual intercourse. In addition, patients who had experience in sexual intercourse were asked about ED through the use of the IIEF5 and whether or not they sought medical help for their ED. RESULTS: Twenty-six patients responded. The positive rates of psychogenic erection, rigidity at erection, ejaculation and orgasm were 85%, 54%, 88% and 65% respectively. Psychogenic erection and ejaculation correlated with Sharrard classification. Rigidity at erection and orgasm correlated with touch sensation on the penis. Eleven patients had experience in sexual intercourse and six of them were diagnosed as having ED on the IIEF5. There were no factors correlating with ED. None of the patients sought medical advice and none was treated for ED. CONCLUSIONS: Sexual function of SB patients could be predicted by Sharrard classification and touch sensation on the penis to some degree. However, ED did not correlate with sexual function. Therefore, we should not evaluate the neurological loss but instead provide adequate information.

Adolescent↗