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Ziapour A, Kazeminia M, Rouzbahani M, Bakhshi S, Montazeri N, Yıldırım M, Tadbiri H, Moradi F, Janjani P. Global prevalence of sexual dysfunction in cardiovascular patients: a systematic review and meta-analysis. Syst Rev 2024; 13:136. [PMID: 38769586 PMCID: PMC11103881 DOI: 10.1186/s13643-024-02525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Sexual dysfunction poses a significant challenge for patients with cardiac conditions. Concerning the prevalence of sexual disorders in cardiovascular patients, several seminal studies conducted in various regions of the world have provided diverse facts and figures pertaining to sexual dysfunction among cardiovascular patients. Therefore, the present study aimed to analyze, summarize, and integrate the findings of seminal studies on the effect of underlying factors and estimate the global rate of sexual disorders in cardiovascular patients. METHODS The present systematic review and meta-analysis included studies conducted in 2003-2023. To find the relevant published academic papers, SID, MagIran, PubMed, Scopus, Web of Science (WOS), and Google Scholar databases were searched for keywords using MeSH/Emtree until January 14, 2023. The GRADEpro software was used to evaluate the quality of evidence. The heterogeneity of studies was checked using the I2 index. RESULTS An initial number of 2122 studies were found in the first search. Following a precise screening process based on predefined inclusion criteria, a total of 17 studies were deemed suitable for inclusion in the meta-analysis. The global prevalence of sexual disorders in cardiovascular patients was estimated at 62.6% (95% CI: 49.8-73.8%). As the results of the meta-regression showed that as the sample size increased, there was a significant decrease in the overall prevalence of sexual disorders among cardiovascular patients. Additionally, as the study years progressed, both age and JBI score exhibited an upward trend. CONCLUSION The present findings showed a high prevalence of sexual disorders among cardiovascular patients. Therefore, it is recommended that experts and health policymakers enhance their focus on effectively preventing and controlling these disorders. Besides the evidence achieved very low certainty, it is important for the treatment team to prioritize the sexual relations of cardiovascular patients and focus on improving their sexual function. This should be seen as an essential aspect of their overall recovery process.
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Affiliation(s)
- Arash Ziapour
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rouzbahani
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeedeh Bakhshi
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nafiseh Montazeri
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Murat Yıldırım
- Department of Psychology, Faculty of Science and Letters, Agri Ibrahim Cecen University, Ağrı, Türkiye
- Graduate Studies and Research, Lebanese American University, Beirut, Lebanon
| | - Hani Tadbiri
- Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Farideh Moradi
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Das J, Yadav S. Comorbidities of male patients with sexual dysfunction in a psychiatry clinic: A study on industrial employees. Ind Psychiatry J 2022; 31:81-88. [PMID: 35800853 PMCID: PMC9255625 DOI: 10.4103/ipj.ipj_116_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/27/2020] [Accepted: 07/21/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Previous studies assessed the association of sexual dysfunction (SD) in cases of specific organic and psychiatric disorders separately as risk factors of SD, but the extent of association of various disorders in cases of SD was rarely evaluated. This study was conducted to assess almost all types of comorbidities to find out their effects on SD in male patients and to make complete diagnoses. MATERIALS AND METHODS All male patients aged between 18 and 60 years reporting with sexual problems to the psychiatry outpatient department were evaluated with Arizona sexual experiences scale (ASEX) for males. Their assessment included detailed medical and psychiatric history including medicine intake, physical and mental status examination. Relevant biochemical investigations were done including sex hormone assessment. RESULTS Among 104 males diagnosed as cases of SD according to the ASEX scale in 1 year period only 75 patients completed all the biochemical and hormonal assessments. It was observed that 38.67% were diagnosed as SD without any comorbidity, 25.33% had biochemical or hormonal or physical comorbidities, 21.33% had psychiatric comorbidities and 14.67% had psychiatric as well as biochemical or hormonal or physical comorbidities (n = 75). The severity of SD was higher in the patients with comorbidity and the age of the patients predicted its severity. CONCLUSION All cases of SD should be assessed in detail for physical, biochemical, hormonal, and psychiatric comorbidities to treat them holistically. Psychiatrists should play a key role in assessing, diagnosing, treating, and referring them to the appropriate treatment provider.
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Affiliation(s)
- Jnanamay Das
- Department of Psychiatry, ESIC Model Hospital, Noida, Uttar Pradesh, India
| | - Shailly Yadav
- Department of Psychiatry, ESIC Model Hospital, Gurugram, Haryana, India
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Prevalence of Erectile Dysfunction and Associated Factors among Hypertensive Patients Attending Governmental Health Institutions in Gondar City, Northwest Ethiopia: A Cross-Sectional Study. Int J Hypertens 2021; 2021:1482500. [PMID: 34868672 PMCID: PMC8642021 DOI: 10.1155/2021/1482500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/11/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Erectile dysfunction is a common sexual problem affecting men with hypertension. It may result in withdrawal from sexual engagement, decreased work productivity, psychosocial problems including poor self-esteem and depression, and reduction in quality of life for both the affected men and their female partners. Objective This study was aimed to determine the prevalence of erectile dysfunction and associated factors among hypertensive patients attending governmental health institutions in Gondar city, Northwest Ethiopia. Materials and Methods An institutional-based cross-sectional study was conducted on 423 hypertensive men randomly selected using a systematic random sampling technique. Erectile dysfunction was assessed using the International Index of Erectile Function-5 tool. Sociodemographic, clinical, and behavioral factors were also collected using pretested interviewer-administered questionnaires. Data were entered into EpiData version 4.6 and analyzed using Stata-14. Binary logistic regression was performed to identify factors associated with erectile dysfunction. The level of significance was computed at a p value ≤ 0.05. Results The mean age of the study participants was 58.84 ± 13.52 years. The prevalence of erectile dysfunction among hypertensive men was 46.34% (95% CI: 41.61, 51.12). About 28% of them had a mild form of erectile dysfunction while nearly 6% had severe forms. Age above 60 years (AOR = 3.8, 95% CI: 1.62, 6.55), stage II hypertension (AOR = 3.5, 95% CI: 1.63, 5.74), hypertension duration >10 years (AOR = 2.5, 95% CI:1.12, 4.19), comorbidity (AOR = 1.7, 95% CI: 1.04, 3.15), depression (AOR = 2.35, 95% CI: 1.31, 4.21), and being physically active (AOR = 0.48, 95% CI: 0.28, 0.83) were factors significantly associated with erectile dysfunction. Conclusion Nearly half of the study participants had some form of erectile dysfunction, indicating the presence of a high burden of the problem. Assessment of hypertensive men for erectile dysfunction should be part of routine medical care.
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Wang JS, Feng JL, Li X, Chen ZL, Bao BH, Deng S, Dai HH, Meng FC, Wang B, Li HS. Effect of leech-centipede medicine on improving erectile function in diabetes-induced erectile dysfunction rats via PDE5 signalling pathway-related molecules. PHARMACEUTICAL BIOLOGY 2021; 59:167-174. [PMID: 33569974 PMCID: PMC7889219 DOI: 10.1080/13880209.2021.1878237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/24/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
CONTEXT The leech and centipede granules have good curative effects on many diabetic vascular diseases, including diabetes-induced erectile dysfunction (DIED). OBJECTIVE To explore the effect of leech and centipede on erectile function in rats with diabetes-induced erectile dysfunction and its possible mechanism. MATERIALS AND METHODS Thirty male Sprague-Dawley DIED rats were randomly divided into the model group (Group M), low-dose group (Group DD), high-dose group (Group DG) and tadalafil group (Group T) (n = 6); diabetic rats were induced by streptozotocin. Apomorphine was used to induce diabetic erectile dysfunction. The 'leech-centipede' granules (0.15 and 0.6 g/kg) were intragastrically administered in the DD and DG groups for 8 weeks. Blood glucose, serum insulin, testosterone, cGMP levels and protein expression changes were measured in each group. RESULTS After 8 weeks, the erectile function of rats in the DG group significantly improved (1.26 ± 0.73). Penis tissue cGMP levels were higher in the DG group (1.48 ± 0.11) than in the M group (0.58 ± 0.15). Protein and mRNA expression levels of NOS were significantly higher (0.77 ± 0.05; 0.61 ± 0.02) but those of PDE5 (0.43 ± 0.05; 0.61 ± 0.03) were lower in the DG group than in the M group (0.37 ± 0.06; 0.51 ± 0.01; 0.78 ± 0.06; 0.81 ± 0.04). CONCLUSION The leech-centipede can improve erectile dysfunction in DIED rats by regulating the expression of cGMP, NOS, and PDE5-related molecules in the PDE5 pathway. This study provides a potential mechanism for the treatment of DIED with leech-centipede.
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Affiliation(s)
- Ji-Sheng Wang
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jun-Long Feng
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Li
- The First Affiliated Hospital, Henan University of Chinese Medicine, Zhengzhou, China
| | - Zi-Long Chen
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bing-Hao Bao
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Sheng Deng
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Heng-Heng Dai
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fan-Chao Meng
- First Clinical Medical College, Beijing University of Chinese Medicine, Beijing, China
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bin Wang
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Song Li
- Andrology Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Getie Mekonnen E, Yeshita HY, Bishaw Geremew A. Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three hospitals of Northwest Amhara region, Ethiopia: Prevalence and associated factors. PLoS One 2021; 16:e0256015. [PMID: 34379695 PMCID: PMC8357135 DOI: 10.1371/journal.pone.0256015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/28/2021] [Indexed: 01/23/2023] Open
Abstract
Background Sexual dysfunction is the commonest reproductive health problem observed among men with diabetes mellitus affecting their quality of life. Previous studies conducted in this area were concentrated on the specific domains of sexual dysfunction, and factors were not well-addressed. Therefore, this study was aimed to determine the prevalence of all forms of sexual dysfunction and to identify its associated factors among diabetic men patients attending at the three hospitals of the Amhara region, Ethiopia. Method An institutional-based cross-sectional study was conducted involving 462 men diabetic patients at the three hospitals of the northwest Amhara region. A systemic random sampling technique was employed. A face-to-face interviewer-administered change in the sexual functioning questionnaire was used to collect the required data from the 20th of February to the 15th of April 2020. The binary logistic regression was employed and a multivariable logistic regressions model was used to control the effect of confounders. Variables that had an independent correlation with the sexual dysfunction were identified based on a p-value≤ 0.05. Likewise, the direction and strength of association were interpreted using Adjusted Odds Ratio (AOR) with its corresponding 95% CI. Results The prevalence of sexual dysfunction was found to be 69.5% (95%CI: (65.1–73.9)). The magnitude of sexual dysfunction was prevalently observed among participants who were older (> 50 years) (AOR = 8.7, 95%CI: (3.3–23.1)). Likewise, the odds of sexual dysfunction was significantly higher among men who have lived with diabetes for a longer duration (AOR = 10.8, 95%CI: (5.3–21.9)), with poor metabolic control (AOR = 3.57, 95%CI: (1.81–7.05)), with comorbid illnesses (AOR = 5.07, 95%CI: (2.16–11.9)), and diabetic-related complications (AOR = 3.01, 95%CI: 1.31–6.92). On the other hand, participants who were physically active (AOR = 0.41, 95%CI: (0.12–0.7)) and satisfied with their relationship (AOR = 0.15, 95%CI: (0.03–0.7)) showed a lesser risk of experiencing sexual dysfunction. Conclusion Well over two-thirds of men with diabetes mellitus have experienced sexual dysfunction, implying a public health pressing problem. Older age, lack of physical activity, living longer duration with diabetes, having diabetic complications, experiencing co-morbid illnesses, being unsatisfied with couple relationship, and poor metabolic control increased the risk of developing SD. Therefore, promoting physical exercise, preventing co-morbid illnesses, and couples counseling to build up a good couple relationship are recommended to promote the sexual and reproductive health of men with diabetes.
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Affiliation(s)
- Eskedar Getie Mekonnen
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Hedija Yenus Yeshita
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alehegn Bishaw Geremew
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Zeleke M, Hailu D, Daka D. Erectile dysfunction and associated factors among diabetic patients at, Hawassa, Southern, Ethiopia. BMC Endocr Disord 2021; 21:139. [PMID: 34210295 PMCID: PMC8252293 DOI: 10.1186/s12902-021-00807-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/23/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Erectile dysfunction is an inability to initiate and have a persistent erection firm enough to have satisfying sexual intercourse. The prevalence of erectile dysfunction in diabetic men is considerably high, but it is often underdiagnosed and under-managed. OBJECTIVE This study aimed to determine erectile dysfunction and associated factors among diabetic patients at, Hawassa, Southern, Ethiopia. METHODS The institution-based cross-sectional study was conducted on 352 adult male diabetic patients randomly selected from Adare general and Hawassa comprehensive specialized hospitals using a simple random sampling technique. The number of patients to be selected from each hospital was proportionally assigned based on the total population of diabetes mellitus patients following chronic care during the study period. The descriptive statistics and multiple logistic regressions (bivariate and multivariate analysis) were carried out. RESULT The prevalence of erectile dysfunction was 72.2% (95%CI, 1.76-3.68). After adjusting all factors, old age, diabetes duration, drinking alcohol, and poor glycemic control had shown significant association with erectile dysfunction. CONCLUSION The occurrence of erectile dysfunction in this study community is very high. Drinking alcohol, poor glycemic control, age, and duration of diabetes were predictors of erectile dysfunction in this study area. Assessment and management of erectile dysfunction in the diabetic clinic should be part of routine medical care during follow-up visits with diabetic patients. Healthcare providers should emphasize screening and treating older patients and those who have had a diabetes diagnosis for a longer duration.
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Affiliation(s)
- Maradona Zeleke
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Dejene Hailu
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Deresse Daka
- Faculty of Medicine, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia.
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Degavi G, Panari H. Determinants and Prevalence of Impotence among Diabetic Patients in Northwestern Hospitals of Nefasit, Eretria. Diabetes Metab Syndr Obes 2021; 14:1177-1182. [PMID: 33758525 PMCID: PMC7981137 DOI: 10.2147/dmso.s297368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Impotence incidence in patients with elevated glycemic index valuesis 30%-69.01%. While impotence is very prevalent among diabetic men, the condition is mostly left unaddressed and needs assessment and care. Impotence can influence the quality of social, mental, leisure, and sexual life, and can contribute to broken relationships, depression, and reduced self-esteem. The goal of the present work was to research the commonness and determinants of impotence among diabetic patients in hospitals in the northwestern region of Nefasit . METHODS A cross-sectional hospital analysis was done of 239 patients with diabetes mellitusin five of six hospitals in Nefasit by means of systemic random sampling. methods. Data were collected for 2 months from Februaryto April 2019. RESULTS The mean age of participants was 43.32 years and mean duration of diabetes 8.7 years. Impotence prevalence was found to be 74.2%: 36.1% mild, 34.2% moderate, and 5.8% serious sexual dysfunction. Statistical analysis showed that impotence was considerably associated with being elderly (AOR 14.21, 95% CI 3.22-70.00), prolonged diabetes (AOR 4.1, 95% CI 1.22-11.16), and lower monthly income (AOR0.279, 95% CI 0.133-0.614). There was no association found with BMI, comorbidity, sugar control, or intake of alcohol. CONCLUSION The prevalence of impotence in the present study was quite high. Very few patients (5.1%) had been screened for impotence. Care of impotent patients in hospitals for diabetes should be a regular health protocol during follow-up care.
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Affiliation(s)
- Girish Degavi
- Department of Nursing, College of Health and Medical Science, Bule Hora University, Hagere Mariam, Ethiopia
- Correspondence: Girish Degavi Department of Nursing, College of Health and Medical Science, Bule Hora University, P.O Box 144, Hagere Mariam, Ethiopia Email
| | - Hazaratali Panari
- Department of Nursing, Institute of Medicine and Health Sciences, Debre Berhan Univerity, Debre Berhan, Ethiopia
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Tridiantari DK, Saraswati LD, Udiyono A. Epidemiology of erectile dysfunction in men with diabetes mellitus: a study in a primary health care center in Indonesia. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.192070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is one of the factors causing erectile dysfunction (ED) and may affect a person's quality of life. This study was aimed to describe the epidemiology of ED in men with DM in a primary health care.
METHODS The study used a cross-sectional study design conducted from January to March 2017 at the Tlogosari Kulon Health Center, Semarang. There were 122 diabetic men who were all included in the study. The data were collected using interviewerassisted questionnaires. The status of ED was measured by the erectile dysfunction intensity scale adapted to the International Index of Erectile Function.
RESULTS The results showed that the prevalence of diabetic men with ED was 84.4%. Most men with ED had age of ≥46 years (91.0%), experienced work stress (88.5%), had low physical activity (93.1%), had obesity (88.0%) of which 86.3% had central obesity, smoking (84.6%), had DM >5 years (91.2%), and took antihypertensive drugs (90.0%). The fasting blood glucose level of respondents ≥126 mg/dl was 86.0%, and 91.7% had sexual desire disorder. The duration of DM and aging are contributing factors of ED in males with DM, with a p-value of 0.016 and 0.013, respectively.
CONCLUSIONS The prevalence of ED in primary health care is still high, and the determining factors were the duration of DM and aging. Public health centers are advised to undertake health promotion on the prevention of factors that can lead to sexual dysfunction in males with DM.
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Chung PL, Huang CW, Lee MJ, Yang YH, Chen KJ, Lu ML, Weng JC, Chen VCH. Effect of Depression and Antidepressants on Sexual Dysfunction in Men with Diabetes: A National Population-Based Cohort Study. Neuropsychiatr Dis Treat 2020; 16:1105-1112. [PMID: 32431505 PMCID: PMC7200718 DOI: 10.2147/ndt.s242798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/09/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This study explored and compared the effects of depression and antidepressants on sexual dysfunction in men with diabetes mellitus (DM). PATIENTS AND METHODS Patients older than 18 years who had been newly diagnosed with DM (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 250) between 1999 and 2010 were identified from Taiwan's National Health Insurance Research Database and were followed up until 2013. Patients with preexisting depression or sexual dysfunction were excluded. A total of 636,210 patients with DM were enrolled. These patients were divided into two groups: DM with comorbid depression and a matched cohort without depression. The groups were followed up until the end of 2010 for the first diagnosis of sexual dysfunction (ICD-9-CM codes 302.70, 302.71, 302.72, 302.74, 302.75, 302.76, 302.79, 607.84, and V417). A Cox proportional hazard model and a Cox regression model with time-dependent covariates were applied. RESULTS Patients with DM and depression had a higher risk of sexual dysfunction than those with DM without depression (hazard ratio [HR] = 1.44; 95% confidence interval [CI], 1.33-1.55). The risk of sexual dysfunction was lower in the subgroup who used antidepressants (per 28 cumulative defined daily doses [cDDDs]), HR = 0.96; 95% CI, 0.94-0.97). A significantly lower incidence of sexual dysfunction was also associated with the use of selective serotonin reuptake inhibitors (SSRIs, per 28 cDDD). The adjusted HR was 0.95 (95% CI, 0.93-0.97). Subgroup analysis indicated that SSRI use was significantly associated with an amelioration of erectile dysfunction (per 28 cDDD), with an HR of 0.95 (95% CI, 0.92-0.97). CONCLUSION Male patients with DM and depression are at increased risk of sexual dysfunction. Antidepressant use had a small inverse association with the risk of sexual dysfunction in men with DM and depression. Antidepressants, in particular SSRIs, did not increase the risk of sexual dysfunction in this population.
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Affiliation(s)
- Pei-Lun Chung
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Chien-Wei Huang
- Division of Nephrology, Department of Medicine, School of Medicine, Kaohsiung Veterans General Hospital, and National Yang-Ming University, Taiwan
| | - Min-Jing Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan.,Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Ugwumba FO, Okafor CI, Nnabugwu II, Udeh EI, Echetabu KN, Okoh AD, Okorie JC. Prevalence of, and risk factors for erectile dysfunction in male type 2 diabetic outpatient attendees in Enugu, South East Nigeria. Ann Afr Med 2019; 17:215-220. [PMID: 30588936 PMCID: PMC6330780 DOI: 10.4103/aam.aam_3_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Context: Erectile dysfunction (ED) is a strong predictor of poor quality of life in men with type 2 Diabetes mellitus (T2DM). Several studies evaluating ED in men with diabetes mellitus have been carried out, but few of these have been done in Nigeria. In Enugu, South East Nigeria, paucity of studies on this subject was observed. Aims: This study aims to determine the prevalence and predictors of ED in men with T2DM attending the diabetes clinics. Settings and Design: A descriptive cross-sectional study of men with T2DM in UNTH and Saint Mary's Hospital, Enugu, was carried out. The systematic sampling method was used to recruit participants. Subjects and Methods: Data collection from participants and their hospital records was done using semi-structured questionnaire. ED was assessed using the 5 items, international index of erectile function questionnaire. Statistical Analysis Used: Data analysis was done using SPSS version 20 and results presented as texts and tables. P value was set at <0.05. Results: A total of 325 participants with mean age of 57.8 ± 13.2 years were involved out of which 94.7% had ED. The proportion of participants with ED had increased with its severity. Predictors of ED included poor glycemic control, longer duration of diabetes, overweight/obesity, and older age. Poor ED health-seeking behavior and treatment were noted. Conclusions: The prevalence of ED is high. Lifestyle interventions targeted at improving glycemic control and weight loss may reduce the burden of this complication. We recommend objective ED screening using standard but brief instruments as part of routine evaluation of men with T2DM.
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Affiliation(s)
- Fred O Ugwumba
- Urology Unit, Department of Surgery, Faculty of Medical Sciences, University of Nigeria, Ituku Ozalla Campus; Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Christian I Okafor
- Endocrinology Unit, Department of Medicine, Faculty of Medical Sciences, University of Nigeria, Ituku Ozalla Campus; Endocrinology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Ikenna I Nnabugwu
- Urology Unit, Department of Surgery, Faculty of Medical Sciences, University of Nigeria, Ituku Ozalla Campus; Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Emeka I Udeh
- Urology Unit, Department of Surgery, Faculty of Medical Sciences, University of Nigeria, Ituku Ozalla Campus; Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Kevin N Echetabu
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Agharighom D Okoh
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - John C Okorie
- Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
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Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med 2019; 16:410-417. [PMID: 30846114 DOI: 10.1016/j.jsxm.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Tighter blood pressure control is widely thought to be associated with better erectile function, although the preponderance of data is limited to dichotomous representations of hypertension without an attempt to look at degree of blood pressure control. AIM To determine the association between optimal blood pressure control over time and the development of erectile dysfunction (ED) in a cohort of potent men. METHODS We performed a retrospective cohort study of newly diagnosed hypertensive men without major medical comorbidities in an integrated healthcare system. Patients were stratified by exposure to hypertension, with varying levels of blood pressure control, as measured by ordinal categories of systolic blood pressure and deviation from the mean systolic pressure. MAIN OUTCOME MEASURES Incidence of ED was defined by at least 2 primary care or urology diagnoses of ED in our electronic health records within 2 years, at least 2 filled prescriptions for ED medications within 2 years, or 1 diagnosis of ED and 2 filled prescriptions for ED medications. RESULTS We identified 39,320 newly diagnosed hypertensive men. The overall incidence for ED was 13.9%, with a mean follow-up of 55.1 ± 28.7 months. Higher average systolic blood pressure was associated with a higher risk of ED in a dose-dependent manner (trend test, P < .001). Wide variation in blood pressure control was associated with a higher incidence of ED (OR [95% CI]; 1.359 [1.258-1.469]) and a shorter time to the development of ED (log rank, P < .0001). CLINICAL IMPLICATIONS We believe these data may serve as a motivator for hypertensive men to better adhere to their hypertension treatment regimen. STRENGTH & LIMITATIONS The retrospective nature of our study precludes us from drawing more than an association between tighter blood pressure control and ED. Strengths of our study include the large sample size, community cohort, and completeness of follow-up. CONCLUSION Among adults diagnosed with hypertension, tighter blood pressure control, as measured by average systolic blood pressure and deviation from the average, is associated with a lower incidence and a longer time to the development of ED. Hsiao W, Bertsch RA, Hung Y-Y, et al. Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med 2019;16:410-417.
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Martín A, Bravo M, Arrabal M, Magán-Fernández A, Mesa F. Chronic periodontitis is associated with erectile dysfunction. A case-control study in european population. J Clin Periodontol 2018; 45:791-798. [DOI: 10.1111/jcpe.12909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/13/2018] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Amada Martín
- Department of Periodontics; School of Dentistry; University of Granada; Granada Spain
| | - Manuel Bravo
- Department of Preventive and Community Dentistry; School of Dentistry; University of Granada; Granada Spain
| | - Miguel Arrabal
- Urology Unit; Granada University Hospital Complex; Granada Spain
| | | | - Francisco Mesa
- Department of Periodontics; School of Dentistry; University of Granada; Granada Spain
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Heikkilä A, Kaipia A, Venermo M, Kautiainen H, Korhonen P. Relationship of Blood Pressure and Erectile Dysfunction in Men Without Previously Diagnosed Hypertension. J Sex Med 2017; 14:1336-1341. [PMID: 28993149 DOI: 10.1016/j.jsxm.2017.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/04/2017] [Accepted: 09/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is the most common male sexual disorder that affects all age groups and has a close association with essential hypertension. AIM To characterize the relation of blood pressure and ED in detail. METHODS A cross-sectional population-based study of 45- to 70-year-old men without previously diagnosed hypertension, cardiovascular diseases, renal disease, or diabetes was conducted from 2005 to 2007 in southwestern Finland. A total of 665 men with at least one cardiovascular risk factor were studied. ED was defined by the five-item International Index of Erectile Function. OUTCOMES We found a U-shaped association between diastolic blood pressure (DBP) and prevalence of ED. RESULTS The average age of the study subjects was 56 ± 6 years and 52% had ED. After adjustment for age, cohabitation status, education, fasting plasma glucose level, waist circumference, and prevalence of depressive symptoms, the curve relating DBP to the prevalence of ED was U-shaped with a nadir of DBP 90 mm Hg. CLINICAL IMPLICATIONS Our findings emphasize the importance of blood pressure measurement in the physical examination of men with ED. STRENGTHS AND LIMITATIONS This was a cross-sectional study, which prevents the evaluation of causality between ED and hypertension. However, this community-based study population is well defined and the anthropologic measurements were made by trained medical staff. CONCLUSION We found a U-shaped correlation between ED and DBP, which confirms the link between ED and hypertension. Heikkilä A, Kaipia A, Venermo M, et al. Relationship of Blood Pressure and Erectile Dysfunction in Men Without Previously Diagnosed Hypertension. J Sex Med 2017;14:1336-1341.
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Affiliation(s)
- Arto Heikkilä
- Department of General Practice, Turku University and Turku University Hospital, Turku University, Turku, Finland.
| | - Antti Kaipia
- Department of Surgery, Satakunta Hospital District, Pori, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland; Folkhälsan Research Centre, Helsinki, University of Helsinki, Helsinki, Finland
| | - Päivi Korhonen
- Department of General Practice, Turku University and Turku University Hospital, Turku University, Turku, Finland; Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
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Seid A, Gerensea H, Tarko S, Zenebe Y, Mezemir R. Prevalence and determinants of erectile dysfunction among diabetic patients attending in hospitals of central and northwestern zone of Tigray, northern Ethiopia: a cross-sectional study. BMC Endocr Disord 2017; 17:16. [PMID: 28298205 PMCID: PMC5353861 DOI: 10.1186/s12902-017-0167-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 03/07/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The prevalence of erectile dysfunction among diabetic men varies between 35-90%. Although erectile dysfunction is widespread among men with diabetes, the condition often remains undiagnosed and demands appropriate assessment and prompt treatment. Erectile dysfunction can affect all aspects of a patient's life including physical, emotional, social, sexual, and relationships. The main aim of this study is to determine the prevalence and determinants of erectile dysfunction among diabetic patients attending hospitals in the Central and Northwest zone of Tigray, Ethiopia. METHODS A hospital based cross-sectional study was conducted on 249 male diabetic patients attending five hospitals in the Central and Northwestern Zone of Tigray, Ethiopia using systematic random sampling. The data was collected from January 1 - February 30, 2016 and was entered and analyzed using SPSS version 20. Correlation and multivariate logistic regression was employed to test associations between independent and outcome variables. RESULTS The mean age of study participants was 43.39 years and the mean duration of diabetes diagnosis was 6.22 years. The overall prevalence of erectile dysfunction was 69.9%, with 32.9% suffering from mild, 31.7% moderate, and 5.2% severe erectile dysfunction. Multivariate logistic regression revealed that erective dysfunction was significantly predicted by old age (Adjusted Odds Ratio [AOR] =15.013, CI:3.212-70.166), longer duration of diabetes (AOR = 3.77, CI:1.291-11.051), and lower monthly income (AOR = 0.285, CI:0.132-0.615). No association was found with body mass index, co-morbidity, glycemic control, and alcohol consumption. CONCLUSION The prevalence of erective dysfunction in this study population was very high. Age, income, and duration of diabetes were the independent predictors of erectile dysfunction. Nearly all of the patients in the sample (97%) had not been screened or treated for erectile dysfunction. Assessment and management of erectile dysfunction in the diabetic clinic should be part of routine medical care during follow-up visits with diabetic patients. Healthcare providers should put an emphasis on screening and treating older patients and those who had a diabetes diagnosis for a longer duration.
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Affiliation(s)
- Awole Seid
- Department of Nursing, Aksum University, Aksum, Ethiopia
- Po.box. 1010, Aksum, Ethiopia
| | - Hadgu Gerensea
- Department of Nursing, Aksum University, Aksum, Ethiopia
| | - Shambel Tarko
- Department of Nursing, Aksum University, Aksum, Ethiopia
| | - Yosef Zenebe
- Department of Psychiatric Nursing, Aksum University, Aksum, Ethiopia
| | - Rahel Mezemir
- Department of Surgical Nursing, St. Paul Medical College, Addis Ababa, Ethiopia
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Binmoammar TA, Hassounah S, Alsaad S, Rawaf S, Majeed A. The impact of poor glycaemic control on the prevalence of erectile dysfunction in men with type 2 diabetes mellitus: a systematic review. JRSM Open 2016; 7:2054270415622602. [PMID: 26981254 PMCID: PMC4776250 DOI: 10.1177/2054270415622602] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective To determine the impact of poor glycaemic control on the prevalence of erectile dysfunction among men with type 2 Diabetics aged 27 to 85 years. Design The databases Embase classic+Embase, Global health, Ovid Medline and PsychINFO, were searched for relevant studies in June 2014 using the keywords: (Diabetes Mellitus OR diabetes mellitus type2 OR DM2 OR T2DM OR insulin resistance) AND (erectile dysfunction OR sexual dysfunction OR impotence) AND glycaemic control. Setting All study settings were considered (primary care, secondary care and tertiary care setting). Participants Type 2 Diabetic Patients with erectile dysfunction. Main outcome measures Included studies must include one of the following outcomes: (1) HBA1c for assess the level of glycaemic control; (2) Erectile dysfunction (any stage: IIEF-5 = 21 or less). Results Five cross-sectional studies involving 3299 patients were included. The findings pointed to a positive association between erectile dysfunction and glycaemic control. Three studies showed a significant positive association, while one study showed only a weak correlation and one study showed borderline significance. Patients’ age, diabetes mellitus duration, peripheral neuropathy and body mass index had positive association with erectile dysfunction. However, smoking and hypertension were not associated with erectile dysfunction in most included studies. Physical activity had a protective effect against erectile dysfunction. Conclusion We may conclude that the risk of erectile dysfunction is higher in type 2 diabetic men with poor glycaemic control than those with good control.
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Affiliation(s)
| | - Sondus Hassounah
- Imperial College London, Charing Cross Hospital, London W6 8RP, UK
| | - Saad Alsaad
- Imperial College London, Charing Cross Hospital, London W6 8RP, UK
| | - Salman Rawaf
- Imperial College London, Charing Cross Hospital, London W6 8RP, UK
| | - Azeem Majeed
- Imperial College London, Charing Cross Hospital, London W6 8RP, UK
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De A, Singh MF, Singh V, Ram V, Bisht S. Treatment effect of l-Norvaline on the sexual performance of male rats with streptozotocin induced diabetes. Eur J Pharmacol 2015; 771:247-54. [PMID: 26671005 DOI: 10.1016/j.ejphar.2015.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 12/31/2022]
Abstract
Sexual impairment is an established risk factor in diabetes mellitus affecting about 75% of male diabetic population. In diabetes overexpression of arginase leads to decreased production of NO and diminished erectile response. Inhibition of arginase enzyme can lead to improvement in diabetes induced sexual dysfunction. In the present study diabetes mellitus was induced in adult male rats by intraperitoneal injection of single dose of streptozotocin (65mg/kg) in 0.1M Citrate buffer pH 4.5 and after 72h fasting serum glucose level was checked by glucose oxidase-peroxidase method and those animals showing FSG above 250mg/dl were selected. Diabetic animals were divided into four groups comprising six animals in each. l-Norvaline, potent arginase inhibitor was administered at a dose of 10mg/kg ip to the different groups of diabetic animals for a period of 30 days. Sildenafil at a dose of 5mg/kg orally was used as a standard drug. Mating behavior tests were performed at 0, 15th and 30th days. After 30 days, various biochemical and hormonal parameters (nitrates, LDH, urea, testosterone), testicular parameters (total protein, nitrates, LDH, total cholesterol, LDL, triglycerides, VLDL, HDL) were evaluated to find out the effect of l-Norvaline in sexual impairment. Sperm analysis was also carried out for the treated rats. l-Norvaline showed significant improvement in serum nitrates, urea, LDH, testosterone and testicular protein level as compared with diabetic group. It also improved sperm motility, count and viability in diabetic rats. Sildenafil showed no improvement in above parameters except restoration in serum nitrates level.
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Affiliation(s)
- Abhijit De
- Department of Pharmaceutical Sciences, SBSPG (I), Balawala, Dehradun, Uttarakhand.
| | - Mamta F Singh
- Department of Pharmaceutical Sciences, SBSPG (I), Balawala, Dehradun, Uttarakhand.
| | - Vinod Singh
- Faculty of Pharm. Sciences, Gurukul Kangri University, Haridwar, Uttarakhand
| | - Veerma Ram
- Department of Pharmaceutical Sciences, SBSPG (I), Balawala, Dehradun, Uttarakhand
| | - Shradha Bisht
- Department of Pharmaceutical Sciences, SBSPG (I), Balawala, Dehradun, Uttarakhand
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Park JH, Ovbiagele B, Feng W. Stroke and sexual dysfunction - a narrative review. J Neurol Sci 2015; 350:7-13. [PMID: 25682327 DOI: 10.1016/j.jns.2015.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/09/2015] [Accepted: 02/01/2015] [Indexed: 11/30/2022]
Abstract
Sexual function is an essential part of quality of life in adults. However, sexual dysfunction (SD) in stroke survivors is a common but under-recognized complication after stroke. It is frequently neglected by patients and clinicians. The etiology of post-stroke SD, which is multifactorial includes anatomical, physical and psychological factors. Complete return of sexual function is an important target for functional recovery after stroke, so clinicians need to be aware of this issue and take a lead role in addressing this challenge in stroke survivors. Accurate diagnosis and prompt treatment of post-stroke SD should be routinely incorporated into comprehensive stroke rehabilitation. This narrative review article, outlines the anatomy and physiology of sexual function, discusses various factors contributing to post-stroke SD, and proposes directions for future research.
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Affiliation(s)
- Jong-Ho Park
- Department of Neurology, Myongji Hospital, Goyang, South Korea; Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, SC, United States
| | - Bruce Ovbiagele
- Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, SC, United States
| | - Wuwei Feng
- Department of Neurology, MUSC Stroke Center, Medical University of South Carolina, Charleston, SC, United States.
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Fafiolu AS, Adebayo AM, Akande TO, Akinboboye OO. Erectile dysfunction among male hypertensives in a tertiary health facility in South-West Nigeria. Glob J Health Sci 2014; 7:154-60. [PMID: 25560353 PMCID: PMC4796473 DOI: 10.5539/gjhs.v7n1p154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/03/2014] [Accepted: 07/20/2014] [Indexed: 01/27/2023] Open
Abstract
Introduction: Erectile dysfunction (ED) has been associated with hypertension and some other chronic diseases. There are few studies on ED in Nigerian male hypertensives and ED appears to be under-reported. We sought to determine the prevalence of ED among hypertensive and normotensive men and to assess the association of demographics, hypertension, antihypertensive medications and other risk factors with erectile function. Methods: A comparative cross sectional study was conducted among male adult hypertensive and normotensive patients attending the outpatient clinic of a tertiary hospital in South-West Nigeria. A systematic random sampling method was employed for the selection of respondents. Participants were interviewed using a semi-structured questionnaire to document socio-demographic data, medical history, social history and degree of ED. Demographic and anthropometric characteristics was obtained from all participants. The International Index of Sexual Health Inventory for men (SHIM) was used to determine the presence and severity of ED. Association between categorical independent variables and erectile function were tested using Chi square and the predictors of erectile dysfunction determined with binary logistic regression model at 5% level of significance. Results: A total of 202 male patients completed the study (101 with established hypertension and 101 normotensives who served as comparative group). The mean age of the respondents was 49.74 ± 16.6 years. A total of 133 (65.8%) respondents had ED in varying severities while 34.2% had normal erectile function. Mild to moderate ED occurred in 29.7% while 36.1% had severe ED. On bivariate analysis, prevalence of ED was higher among hypertensives (75%) than normotensives (56.9%) and this was statistically significant, p = 0.007. On multivariate analysis, the only significant risk factor for ED was age. The elderly aged ≥ 65 years (OR: 2.9; 95% CI: 1.03–8.35; p = 0.04) and those aged 46–64 years (OR: 2.9; 95% CI: 1.38–6.53; p = 0.006) were 3 times each more likely to have erectile dysfunction compared with those aged ≤ 45 years. Conclusion: This study revealed that erectile dysfunction was prevalent in both hypertensive and normotensive population studied and that this was significantly worse with increasing age. A higher proportion of hypertensives compared to normotensives had erectile dysfunction. We recommend that all men presenting to a physician should have routine evaluation for ED so as to recognise it early and reduce its effects.
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Clavijo RI, Miner MM, Rajfer J. Erectile Dysfunction and Essential Hypertension: The Same Aging-related Disorder? Rev Urol 2014; 16:167-171. [PMID: 25548543 PMCID: PMC4274173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An erection is a mechanical event dependent primarily on corporeal vascular dynamics wherein arterial inflow and storage of blood within the corpora is greater than the egress of blood from the corpora. The most common cause of erectile dysfunction (ED) is the inability of the corporal tissue to store the blood within the corporal sinusoids once inflow into the corpora begins. This failure to store is primarily due to a corporal smooth muscle dysfunction and, in most men, is most likely an aging-related occurrence. Because the corporal smooth muscle is embryologically and physiologically indistinguishable from the smooth muscle within our arterial system, the authors hypothesize that the aging-related dysfunction that occurs within the penis also occurs within the arterial system, and that this smooth muscle dysfunction within the arterial media is most likely the cause of what is called essential hypertension. This panvascular smooth muscle myopathy could explain why hypertension is the most common comorbidity associated with ED and appears to indicate that both ED and essential hypertension are the same disorder, albeit in two different organ systems.
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Affiliation(s)
- Raul I Clavijo
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Jacob Rajfer
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Abstract
Diabetes mellitus is one of the most common chronic diseases in nearly all countries. It has been associated with sexual dysfunction, both in males and in females. Diabetes is an established risk factor for sexual dysfunction in men, as a threefold increased risk of erectile dysfunction was documented in diabetic men, as compared with nondiabetic men. Among women, evidence regarding the association between diabetes and sexual dysfunction are less conclusive, although most studies have reported a higher prevalence of female sexual dysfunction in diabetic women as compared with nondiabetic women. Female sexual function appears to be more related to social and psychological components than to the physiological consequence of diabetes. Hyperglycemia, which is a main determinant of vascular and microvascular diabetic complications, may participate in the pathogenetic mechanisms of sexual dysfunction in diabetes. Moreover, diabetic people may present several clinical conditions, including hypertension, overweight and obesity, metabolic syndrome, cigarette smoking, and atherogenic dyslipidemia, which are themselves risk factors for sexual dysfunction, both in men and in women. The adoption of healthy lifestyles may reduce insulin resistance, endothelial dysfunction, and oxidative stress - all of which are desirable achievements in diabetic patients. Improved well-being may further contribute to reduce and prevent sexual dysfunction in both sexes.
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Affiliation(s)
- Maria Ida Maiorino
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Giuseppe Bellastella
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
- Correspondence: Katherine Esposito, Endocrinology and Metabolic Diseases Unit, University Hospital at Second University of Naples, Piazza L Miraglia no 2, 80138 Napoli, Italy, Tel +39 081 566 5031, Fax +39 081 566 5054, Email
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Fadzil MA, Sidi H, Ismail Z, Hassan MRC, Thuzar K, Midin M, Nik Jaafar NR, Das S. Socio-demographic and psychosocial correlates of erectile dysfunction among hypertensive patients. Compr Psychiatry 2014; 55 Suppl 1:S23-8. [PMID: 23453753 DOI: 10.1016/j.comppsych.2012.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/31/2012] [Accepted: 12/31/2012] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The main aim of the study was to estimate the prevalence of ED and the associated socio-demographic and psychological correlates among hypertensive patients from a rural multiethnic community in Malaysia. METHODS A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The socio-demographic, health characteristics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of ErectileFunction-5 (IIEF-5) questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress, respectively. RESULTS A total of 253 hypertensive patients comprising 178 (70.4%) Malays, 56 (22.1%) Chinese and 18 (7.5%) Indians participated. The mean age of participants was 59.8 ± 10.62 years. Overall, the prevalence rate of ED was 62%: 90 (35%) with moderate and 69 (27%) with severe ED. The prevalence rate of ED among those aged 65 years or older (83.1%) was significantly higher than those less than 65 years (51.8%), (p<0.001). Higher prevalence rates were also noted among the Chinese (78.6%) compared to Malays (59.6%) and Indians (50%) (p=0.021); lower education level (69.1%) (p=0.026), among hypertensive patients with concomitant diabetes mellitus (70.6%) (p=0.026) and WHR ≥ 0.9 (31.3%) (p=0.021). However, no significant association was found between depression, anxiety and stress scores with IIEF-5 score. CONCLUSION The prevalence rate of ED among Malaysian hypertensive patients is high. The rate increases significantly with age, Chinese ethnicity, concomitant diabetes mellitus, lower education level, WHR and the number of pack years of smoking. ED should be properly recognized and managed in hypertensive patients.
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Rajfer J, Miner MM. Hypertension: The Link Between Erectile Dysfunction and Coronary Artery Disease. JOURNAL OF MEN'S HEALTH 2013. [DOI: 10.1089/jomh.2013.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kupelian V, Hall SA, McKinlay JB. Common prescription medication use and erectile dysfunction: results from the Boston Area Community Health (BACH) survey. BJU Int 2013; 112:1178-87. [PMID: 23819576 DOI: 10.1111/bju.12231] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the association of erectile dysfunction (ED) with commonly used medications including antihypertensive treatment (AHT), psychoactive medication and pain and anti-inflammatory medication. SUBJECTS AND METHODS The Boston Area Community Health (BACH) survey used a multistage stratified design to recruit a random sample of 2301 men aged 30-79 years. ED was assessed using the five-item International Index of Erectile Function (IIEF-5). Prescription medications, captured using a combination of drug inventory and self-report with a prompt by indication, included in this analysis comprised AHT, psychoactive medication, and pain and anti-inflammatory medication. Logistic regression was used to estimate the odds ratios (ORs) of the association of medication use with ED and to adjust for potential confounders including age, comorbid conditions and sociodemographic and lifestyle factors. RESULTS Multivariable analyses showed benzodiazepines (adjusted OR = 2.34, 95% confidence interval [CI]: 1.03, 5.31) and tricyclic antidepressants (adjusted OR = 3.35, 95% CI: 1.09, 10.27) were associated with ED, while no association was observed for serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and atypical antipsychotics. The use of AHT, whether in monotherapy or in conjunction with other AHTs, and pain or anti-inflammatory medications were not associated with ED after accounting for confounding factors. CONCLUSIONS Results of the BACH survey suggest adverse effects of some psychoactive medications (benzodiazepines and tricyclic antidepressants). No evidence of an association of AHT or pain and anti-inflammatory medication with ED was observed.
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Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, Castiglione F, Briganti A, Cantiello F, Damiano R, Montorsi F, Salonia A. One patient out of four with newly diagnosed erectile dysfunction is a young man--worrisome picture from the everyday clinical practice. J Sex Med 2013; 10:1833-41. [PMID: 23651423 DOI: 10.1111/jsm.12179] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a common complaint in men over 40 years of age, and prevalence rates increase throughout the aging period. Prevalence and risk factors of ED among young men have been scantly analyzed. AIM Assessing sociodemographic and clinical characteristics of young men (defined as ≤ 40 years) seeking first medical help for new onset ED as their primary sexual disorder. METHODS Complete sociodemographic and clinical data from 439 consecutive patients were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF). MAIN OUTCOME MEASURE Descriptive statistics tested sociodemographic and clinical differences between ED patients ≤ 40 years and >40 years. RESULTS New onset ED as the primary disorder was found in 114 (26%) men ≤ 40 years (mean [standard deviation [SD]] age: 32.4 [6.0]; range: 17-40 years). Patients ≤ 40 years had a lower rate of comorbid conditions (CCI = 0 in 90.4% vs. 58.3%; χ(2) , 39.12; P < 0.001), a lower mean body mass index value (P = 0.005), and a higher mean circulating total testosterone level (P = 0.005) as compared with those >40 years. Younger ED patients more frequently showed habit of cigarette smoking and use of illicit drug, as compared with older men (all P ≤ 0.02). Premature ejaculation was more comorbid in younger men, whereas Peyronie's disease was prevalent in the older group (all P = 0.03). At IIEF, severe ED rates were found in 48.8% younger men and 40% older men, respectively (P > 0.05). Similarly, rates of mild, mild-to-moderate, and moderate ED were not significantly different between the two groups. CONCLUSIONS This exploratory analysis showed that one in four patients seeking first medical help for new onset ED was younger than 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients. Overall, younger men differed from older individuals in terms of both clinical and sociodemographic parameters.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
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Wei AY, He SH, Zhao JF, liu Y, Liu Y, Hu YW, Zhang T, Wu ZY. Characterization of corpus cavernosum smooth muscle cell phenotype in diabetic rats with erectile dysfunction. Int J Impot Res 2012; 24:196-201. [PMID: 22592762 DOI: 10.1038/ijir.2012.16] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 03/16/2012] [Accepted: 04/10/2012] [Indexed: 11/08/2022]
Abstract
Phenotypic modulation from a contractile to a proliferative state within vascular smooth muscle cells has a critical role in the pathogenesis of a variety of cardiovascular diseases. To investigate the characterization of corpus cavernosum smooth muscle cell phenotype in diabetic rats with erectile dysfunction, a group of Sprague-Dawley rats (n=30) were induced by intraperitoneal injection of streptozotocin (60 mg kg(-1)) and screened by subcutaneous injection of apomorphine (100 μg kg(-1)) for the measurement and comparison of the penile erections, and then three different groups were defined. Primary corpus cavernosum smooth muscle cells were cultured and passaged. The cavernous tissue segments were subjected to quantitative real-time polymerase chain reaction to determine the expressions of smooth muscle α-actin (SMA), SM myosin heavy chain (SMMHC), smoothelin, calponin and myocardin. Cell contractility in vitro and western blot analysis of SMA and SMMHC in the cavernous tissues and cells were determined. Compared with the control group (n=8) and the diabetes mellitus group (n=5), the expressions of SMA, calponin, SMMHC, smoothelin and myocardin mRNA were decreased in the cavernous tissues in rats of the diabetic erectile dysfunction group (n=15; P=0.001 and 0.02, P=0.014 and 0.012, both P<0.001, P=0.005 and <0.001, P=0.003 and 0.035, respectively). The levels of SMA and SMMHC proteins showed a significant decrease in cavernous tissues and cultured cells in rats of the diabetic erectile dysfunction group. Cells of the diabetic erectile dysfunction group exhibited significantly less contractility compared with those of other groups (P<0.001). Corpus cavernosum SM cell possesses the ability to modulate the phenotype under hyperglycemic conditions, which could have a key role in the pathogenesis of diabetic erectile dysfunction.
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Affiliation(s)
- A-Y Wei
- Department of Urology, Medical Center for Overseas Patients, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Bener A, Al-Ansari A, Afifi M, Krishna PV. Erectile dysfunction among hypertensive men in a rapidly developing country. Indian J Urol 2011; 23:109-13. [PMID: 19675783 PMCID: PMC2721515 DOI: 10.4103/0970-1591.32057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Previous studies have supported the association between hypertension and erectile dysfunction (ED). In addition, a significant correlation between hypertension in men and ED has been well established. Objectives: The aim of this study was to investigate the prevalence of ED, its severity and other sexual function domains in hypertensive patients in Qatar. Design and Setting: Cross-sectional study conducted between January and December 2006 at the Hamad General Hospital. Subjects: Qatari and nonQatari nationals 25 to 75 years of age were approached to participate in this study, 642 (75.5%) gave their consent. Materials and Methods: Qatari and nonQatari men aged 25 to 75 years who gave consent were interviewed face-to-face. Sexual function was evaluated with the International index of erectile function. Results: A total of 642 (75.5%) men responded, mean age of subjects was 57.1 ± 11.9 years. The prevalence of ED in hypertensive patients was 58.3%. 21.2% of hypertensive men reported severe ED, 20.7% moderate ED and 16.4% mild ED. The comorbidities and risk factors were significantly more prominent in ED patients than in those with normal ED for hypercholesterolemia (P=0.009), diabetes (P=0.022) for hypertriglyceridemia (P=0.033) and myocardial ischemia (P=0.042). Conclusions: Our results have shown a greater prevalence of ED in the hypertensive men in the population of Qatar. The presence of another risk factor in addition to elevated blood pressure can increase the likelihood of ED.
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Affiliation(s)
- Abdulbari Bener
- Department of Medical Statistics and Epidemiology, Hamad Medical Corporation and Department Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK
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Chew KK, Gibson N, Sanfilippo F, Stuckey B, Bremner A. Cardiovascular Mortality in Men with Erectile Dysfunction: Increased Risk But Not Inevitable. J Sex Med 2011; 8:1761-71. [DOI: 10.1111/j.1743-6109.2011.02239.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thorve VS, Kshirsagar AD, Vyawahare NS, Joshi VS, Ingale KG, Mohite RJ. Diabetes-induced erectile dysfunction: epidemiology, pathophysiology and management. J Diabetes Complications 2011; 25:129-36. [PMID: 20462773 DOI: 10.1016/j.jdiacomp.2010.03.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/16/2010] [Accepted: 03/29/2010] [Indexed: 01/23/2023]
Abstract
Erectile dysfunction (ED) is defined as the inability of the male to attain and maintain erection of penis sufficient to permit satisfactory sexual intercourse. Prevalence of impotence in diabetic men is ≥50%. The pathophysiology of diabetes-induced erectile dysfunction (DIED) is multifactorial and no single etiology is at the forefront. The proposed mechanisms of erectile dysfunction in diabetic patients includes elevated advanced glycation end-products, increased levels of oxygen free radicals, impaired nitric oxide synthesis, increased endothelin B receptor binding sites and up-regulated RhoA/Rho-kinase pathway, neuropathic damage and impaired cyclic guanosine monophosphate (cGMP)-dependent protein kinase-1. The treatment of DIED is multimodal. Treatment of the underlying hyperglycemia and comorbidities is of utmost importance to prevent or halt the progression of disease. Oral medications are considered as the first line therapy for management of DIED. If oral agents cannot be used or have insufficient efficacy despite appropriate dosing and education, second-line treatments should be addressed. When there is lack of efficacy or when there is dissatisfaction with other modalities, penile prostheses are often the best alternative for ED and are considered as the third line therapy for DIED. Future strategies in the evolution of the treatment of DIED are aimed at correcting or treating the underlying mechanisms of DIED.
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Affiliation(s)
- Vrushali S Thorve
- Department of Pharmacology, AISSMS College of Pharmacy, Near R.T.O., Pune-411 001, India
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Baumhäkel M, Schlimmer N, Kratz M, Hackett G, Jackson G, Böhm M. Cardiovascular risk, drugs and erectile function--a systematic analysis. Int J Clin Pract 2011; 65:289-98. [PMID: 21314866 DOI: 10.1111/j.1742-1241.2010.02563.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
AIMS Erectile dysfunction is a major problem with an increasing prevalence in cardiovascular high-risk patients due to its association with cardiovascular risk factors. Drugs used for evidence-based treatment of cardiovascular diseases have been reported to decrease erectile function, but possible mechanisms are poorly characterised. METHODS MEDLINE, EMBASE and Cochrane Registry search were performed including manuscripts until January 2010. Searching terms are: 'erectile dysfunction or impotence' in combination with 'ACE-inhibitors', 'angiotensin', 'beta-blockers', 'calcium antagonist' and 'diuretics'. Animal studies, letters, reviews, case-reports and manuscripts other than English language and trials dealing with combination treatment are excluded. RESULTS Analysis of literature revealed five epidemiological trials evaluating the effect of different cardiovascular drugs on erectile function. There were eight trials evaluating the effect of beta-blockers, five trials evaluating the effect of ace-inhibitors or angiotensin-receptor-blockers and one trial evaluating the effect of diuretics on erectile function. Results of these trials demonstrate that only thiazide diuretics and beta-blockers except nebivolol may adversely influence erectile function. ACE-inhibitors, angiotensin-receptor-blockers and calcium-channel-blockers are reported to have no relevant or even a positive effect on erectile function. CONCLUSION Inappropriate patients' concerns about adverse effects of cardiovascular drugs on erectile function might limit the use of important medications in cardiovascular high-risk patients. Knowledge about the effects of drug-treatments on erectile function and about the major role of the endothelium in penile function might improve patients' adherence to evidence based treatment of cardiovascular diseases.
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Affiliation(s)
- M Baumhäkel
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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Yang G, Pan C, Lu J. Prevalence of erectile dysfunction among Chinese men with type 2 diabetes mellitus. Int J Impot Res 2010; 22:310-7. [PMID: 20811390 DOI: 10.1038/ijir.2010.21] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aims of this study were to investigate the prevalence of ED in Chinese men with type 2 diabetes mellitus, and evaluate the efficacy and safety of sildenafil citrate in these patients. Patients from 42 outpatient diabetes clinics with type 2 diabetes mellitus and ED as defined by the International Index of Erectile Function (IIEF)-5 were studied. Participants with ED received three doses (100 mg each) of sildenafil citrate for use over 3 months. Efficacy of sildenafil citrate was assessed using the IIEF-5 and the Global Efficacy Questionnaire (GEQ). Adverse events were recorded by patients in a daily diary. A total of 5477 participants were evaluated, and 75.2% had ED. Age, duration of diabetes and glycosylated hemoglobin (HbA(1)c) >6.5% were independently and significantly associated with the presence and degree of ED. Patients who received pharmacotherapy (N=389) reported significant improvements. The rate of erections as determined by the GEQ was also significantly improved following treatment. ED is a common complication in Chinese men with type 2 diabetes mellitus, and certain risk factors are associated with the presence of ED and severity. Sildenafil citrate is a safe and effective treatment for these patients.
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Affiliation(s)
- G Yang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
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Physicians' degree of motivation regarding their perception of hypertension, and blood pressure control. J Hypertens 2010. [DOI: 10.1097/hjh.0b013e32833815ee] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang CC, Chancellor MB, Lin JM, Hsieh JH, Yu HJ. Type 2 diabetes but not metabolic syndrome is associated with an increased risk of lower urinary tract symptoms and erectile dysfunction in men aged <45 years. BJU Int 2010; 105:1136-40. [DOI: 10.1111/j.1464-410x.2009.08913.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Chew KK, Finn J, Stuckey B, Gibson N, Sanfilippo F, Bremner A, Thompson P, Hobbs M, Jamrozik K. Erectile dysfunction as a predictor for subsequent atherosclerotic cardiovascular events: findings from a linked-data study. J Sex Med 2009; 7:192-202. [PMID: 19912508 DOI: 10.1111/j.1743-6109.2009.01576.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In spite of the mounting interest in the nexus between erectile dysfunction (ED) and cardiovascular (CV) diseases, there is little published information on the role of ED as a predictor for subsequent CV events. AIM This study aimed to investigate the role of ED as a predictor for atherosclerotic CV events subsequent to the manifestation of ED. Method. The investigation involved the retrospective study of data on a cohort of men with ED linked to hospital morbidity data and death registrations. By using the linked data, the incidence rates of atherosclerotic CV events subsequent to the manifestation of ED were estimated in men with ED and no atherosclerotic CV disease reported prior to the manifestation of ED. The risk of subsequent atherosclerotic CV events in men with ED was assessed by comparing these incidence rates with those in the general male population. MAIN OUTCOME MEASURE Standardized incidence rate ratio (SIRR), comparing the incidence of atherosclerotic CV events subsequent to the manifestation of ED in a cohort of 1,660 men with ED to the incidence in the general male population. RESULTS On the basis of hospital admissions and death registrations, men with ED had a statistically significantly higher incidence of atherosclerotic CV events (SIRR 2.2; 95% confidence interval 1.9, 2.4). There were significantly increased incidence rate ratios in all age groups younger than 70 years, with a statistically highly significant downward trend with increase of age (P < 0.0001) across these age groups. Younger age at first manifestation of ED, cigarette smoking, presence of comorbidities and socioeconomic disadvantage were all associated with higher hazard ratios for subsequent atherosclerotic CV events. CONCLUSIONS The findings show that ED is not only significantly associated with but is also strongly predictive of subsequent atherosclerotic CV events. This is even more striking when ED presents at a younger age.
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Affiliation(s)
- Kew-Kim Chew
- Keogh Institute for Medical Research, Nedlands, Perth, WA, Australia.
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Meena BL, Kochar DK, Agarwal TD, Choudhary R, Kochar A. Association between erectile dysfunction and cardiovascular risk in individuals with type-2 diabetes without overt cardiovascular disease. Int J Diabetes Dev Ctries 2009; 29:150-4. [PMID: 20336196 PMCID: PMC2839128 DOI: 10.4103/0973-3930.57345] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 09/12/2009] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Erectile dysfunction in type-2 diabetes may be an independent marker for coronary artery disease. Present study was undertaken to investigate whether type-2 diabetic patients with erectile dysfunction without having overt cardiovascular disease had increased cardiovascular risk. AIM To find out correlation between ED and cardiovascular risk in diabetic patients. METHODS Fifty type-2 diabetic patients were assessed for erectile dysfunction using international index of erectile dysfunction (IIEF-5), which include questionnaire and cardiovascular risk assessment by multiparameter cardiovascular analysis device (periscope). RESULTS The prevalence of erectile dysfunction in type-2 diabetics was very high (78%), mild, moderate and severe ED was present in 6, 36 and 36%, respectively. The total cardiovascular risk was more in patients with ED in comparison to patients without ED (34.87 +/- 18.82 vs 20.91 +/- 11.03 p = 0.002). The mean 10-years coronary risk and cardiac risk was 12.00 + 9.60 and 22.23 + 14.14 (p = 0.029) and 13.36 +/- 1.22 and 28.85 +/- 4.13 (p 0.002) in patients without ED and with ED respectively. The mean vascular and atherosclerosis risk was 28.73 +/- 13.94 and 39.38 +/- 19.51 (p > 0.05) and 26.18 +/- 10.31 and 33.92 +/- 13.40 (p > 0.05) in patients without ED and with ED, respectively. Total cardiovascular risk was found to increase with age, duration of diabetes and HbA1c levels. CONCLUSION The total cardiovascular risk increases with increasing severity of erectile dysfunction in type-2 diabetic patients without having overt cardiovascular disease.
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Affiliation(s)
- Babu Lal Meena
- Department of Medicine, S.P. Medical College, Bikaner, Rajasthan, India
| | | | - Tulsi Das Agarwal
- Department of Medicine, S.P. Medical College, Bikaner, Rajasthan, India
| | | | - Abhishek Kochar
- Department of Medicine, S.P. Medical College, Bikaner, Rajasthan, India
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Chew KK, Bremner A, Stuckey B, Earle C, Jamrozik K. Sex life after 65: how does erectile dysfunction affect ageing and elderly men? Aging Male 2009; 12:41-6. [PMID: 19378217 DOI: 10.1080/13685530802273400] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION We report the findings pertinent to the ageing and elderly participants of a population-based study of erectile dysfunction (ED). METHOD We examined the sociodemographic characteristics, self-reported morbidities and responses to the 5-item International Index of Erectile Function (IIEF-5) of participants aged > or = 65 years and > or = 80 years. RESULTS Most (73%) participants were married or had partners. Among the participants aged > or = 65 years, the prevalence of ED (IIEF-5 scores <22) was 67% and of severe ED (IIEF-5 scores <8) 48%. About 32% were sexually active, and 11% had regular sexual intercourse. Cardiovascular disease (CVD) was reported in 37% and diabetes mellitus (DM) in 13%, with odds of ED at 3.91 and 4.68, respectively. Among those aged > or = 80 years, the prevalence of ED was 68% and of severe ED 57%. About 12% were sexually active, and 3% had regular sexual intercourse. CVD was reported in 44% and DM in 11%, with corresponding odds of ED at 2.55 and 2.90. CONCLUSIONS Most ageing and elderly men are in a relationship and many are sexually active. ED is prevalent and severe. Morbidities are common and significantly associated with ED, impairing the sex lives of affected men.
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Affiliation(s)
- Kew-Kim Chew
- Keogh Institute for Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia.
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Azuri J, Gelerenter R, Dushinat M, Friedman N, Kokia E. Raising awareness for the diagnosis and treatment of erectile dysfunction in patients with high risk to develop ED. Int J Impot Res 2009; 21:249-52. [DOI: 10.1038/ijir.2009.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cleveringa FGW, Meulenberg MGG, Gorter KJ, van den Donk M, Rutten GEHM. The association between erectile dysfunction and cardiovascular risk in men with Type 2 diabetes in primary care: it is a matter of age. J Diabetes Complications 2009; 23:153-9. [PMID: 18413203 DOI: 10.1016/j.jdiacomp.2007.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 11/11/2007] [Accepted: 12/07/2007] [Indexed: 11/26/2022]
Abstract
AIMS Erectile dysfunction (ED) prevalence is usually based on questionnaires, too elaborate for daily practice. The single question for ED prevalence is unknown. Literature reports an independent association between ED and both cardiovascular disease (CVD) and diabetes. Whether routinely asking men with Type 2 diabetes (DM2) about ED identifies those at elevated risk for CVD is unknown. We assessed cardiovascular risk of DM2 men with ED. DESIGN AND METHODS This was a cross-sectional study in primary care. During annual check-up, the practice nurse asked 1823 DM2 men: "Do you have erection problems? Yes/no." ED prevalence rate was calculated. Age, medication, and other known factors associated with ED and/or CVD were used in univariate analysis (odds ratio [OR], Student's t test, and Mann-Whitney test). This revealed confounding variables used in the multivariable analysis. The association between ED and history of cardiovascular disease (HCVD) was assessed by logistic regression analysis. In patients with no HCVD, we assessed the association between ED and 10-year United Kingdom Prospective Diabetes Study (UKPDS) coronary heart disease risk by linear regression analysis. RESULTS The prevalence of ED in DM2 patients was 41.3%. There was no independent association between ED and HCVD [adjusted OR, 1.2 (95% CI, 0.9-1.5)]. The 10-year UKPDS CHD risk difference between men with and without ED was 5.9% (95% CI, 3.2-8.7), but after adjustment for age, this association disappeared [adjusted risk difference, 0.6% (95% CI, -1.5 to 2.7)]. CONCLUSION The ED prevalence rate assessed by a single question was comparable to that assessed by questionnaires. ED neither did independently relate to patients' cardiovascular history nor to cardiovascular risk.
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Affiliation(s)
- Frits G W Cleveringa
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Erektile Dysfunktion: Indikator für Endorganschädigung beim kardiovaskulären Patienten. ACTA ACUST UNITED AC 2009; 104:309-13. [DOI: 10.1007/s00063-009-1051-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ. Erectile Dysfunction Might Be Associated With Chronic Periodontal Disease: Two Ends of the Cardiovascular Spectrum. J Sex Med 2009; 6:1111-1116. [DOI: 10.1111/j.1743-6109.2008.01141.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Malavige LS, Jayaratne SD, Kathriarachchi ST, Sivayogan S, Fernando DJ, Levy JC. Erectile dysfunction among men with diabetes is strongly associated with premature ejaculation and reduced libido. J Sex Med 2008; 5:2125-34. [PMID: 18624974 DOI: 10.1111/j.1743-6109.2008.00907.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Among men with diabetes, little attention has been given to premature ejaculation (PE), reduced libido, and their associations with erectile dysfunction (ED), despite the presence of physical and psychologic factors that could predispose to all three. AIM To estimate the prevalence and inter-associations of ED, PE, and reduced libido among diabetic men and to describe the associated clinical, socioeconomic, and lifestyle parameters. METHODS Cross-sectional observational study of 253 men with type 2 diabetes randomly selected from a clinic in Colombo, Sri Lanka. MAIN OUTCOME MEASURES Erectile function was assessed using the five-item version of the International Index of Erectile Function scale. The presence of PE, reduced libido, sociodemographic, and lifestyle data was obtained using an interviewer-administered questionnaire. Clinical data were obtained from relevant physical examination, patient records, and laboratory tests, which included glycosylated hemoglobin, serum cholesterol, serum creatinine, and electrocardiogram. RESULTS One hundred and eighty-five (73.1%) of the individuals had some degree of ED, while 84 (33.2%) had severe to complete ED. After excluding men with complete ED, the prevalence of PE was 68 (40.2%). The overall prevalence of reduced libido was 64 (25%). In the multivariate analysis, the strongest associations with ED were PE (odds ratio [OR] = 4.41, 95% confidence interval [CI] = 2.08-9.39) and reduced libido (OR = 4.38, CI = 1.39-13.82) followed by lower income (OR = 2.16, CI = 1.32-3.52), advancing age (OR = 2.06, CI = 1.44-2.95), and duration of diabetes (OR = 1.48, CI = 1.09-2.01). In addition, ED was univariately associated with lower educational level (P = 0.05), the presence of hypertension (P = 0.005), and no alcohol intake (P = 0.001). The only significant association of PE was the severity grade of ED. Associations of reduced libido in the multivariate analysis were ED (OR=1.61, CI = 1.23-2.70), advancing age (OR = 1.7, CI = 1.4-2.2), and absence of masturbation (OR = 3.3, CI = 1.2-8.8). CONCLUSIONS ED was strongly associated with PE and reduced libido. Diabetic patients presenting with one of these three conditions should be screened for the other two.
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Sand MS, Fisher W, Rosen R, Heiman J, Eardley I. Erectile Dysfunction and Constructs of Masculinity and Quality of Life in the Multinational Men's Attitudes to Life Events and Sexuality (MALES) Study. J Sex Med 2008; 5:583-94. [DOI: 10.1111/j.1743-6109.2007.00720.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sadikot S. Is ED a “red” flag for future CVD? Diabetes Metab Syndr 2008. [DOI: 10.1016/j.dsx.2007.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eardley I, Fisher W, Rosen RC, Niederberger C, Nadel A, Sand M. The multinational Men's Attitudes to Life Events and Sexuality study: the influence of diabetes on self-reported erectile function, attitudes and treatment-seeking patterns in men with erectile dysfunction. Int J Clin Pract 2007; 61:1446-53. [PMID: 17655685 DOI: 10.1111/j.1742-1241.2007.01460.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIMS To identify the prevalence of erectile dysfunction (ED) in men with diabetes, and to compare the perceptions of ED and the treatment-seeking behaviour of these men with men with ED without diabetes. METHODS Phase I of this multinational study involved 27,839 men who were questioned about a number of men's health issues including ED, diabetes and cardiovascular conditions (i.e. hypertension, high cholesterol and angina). Epidemiological associations between these conditions were explored. Phase II involved 2912 men with self-reported ED, aged 20-75 years. Participants completed questionnaires concerning their ED, efforts to seek treatment for their ED, and potential influences that might affect treatment-seeking behaviour. Comparison of these responses was made between men with ED and diabetes and men with ED without diabetes. RESULTS There was a clear association between self-reported ED and diabetes, hypertension, angina and high cholesterol. Men with diabetes were more likely to consider their ED to be severe and permanent and to speak to a physician or a nurse about their ED, compared with men without diabetes. Sildenafil use was similar in both groups, but men with diabetes were more likely to have discontinued use, mainly because of the lack of treatment efficacy. CONCLUSION Men with diabetes were more likely to consider their ED to be severe and permanent, compared with men without diabetes. Furthermore, men with diabetes were more likely to discontinue sildenafil therapy, primarily because of poor efficacy. These findings suggest a need for alternative treatments for ED, especially in men with diabetes.
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Affiliation(s)
- I Eardley
- Pyrah Department of Urology, St. James University Hospital, Leeds, UK.
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Tomada I, Tomada N, Vendeira P. Disfunção eréctil e obesidade. Rev Int Androl 2007. [DOI: 10.1016/s1698-031x(07)74071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prasad KV, Al Ansari A, Al Kadhi S, El Malik EF. Evaluation of the Demographics, Prevalence of Risk Factors and Treatment Strategies of Erectile Dysfunction in Qatar. Qatar Med J 2007. [DOI: 10.5339/qmj.2007.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Records of patients attending the Andrology Clinic, Hamad Medical Corporation, Qatar; over a period often years were analyzed to determine the demographic features, contributory risk factors, and best methods of treatment for erectile dysfunction (ED). Of1,245patients with ages ranging from 19-78 years (mean 49 years) 45% were Qataris. Most complained of weak erections, a few reported ejaculatory dysfunction. Diabetes mellitus was the most frequent risk factor (53%) followed by hypertension (28%), smoking (27%) and coronary artery disease (14%). Oral Sildenafil given to 310 patients gave overall satisfaction to 75 (49%) of the 152 patients in whom satisfaction could be assessed; intracorporal injection given to 413 patients resulted in overall satisfaction to 107 (68%) of 157 in whom satisfaction could be assessed; penile prosthesis implantation in 64 patients remained an effective therapeutic modality with 31 (84%) of the 37 patients in whom satisfaction could be assessed being satisfied with the results.
Conclusion: Erectile dysfunction is as common in Qatar as it is in the rest of the world. The higher incidence of diabetes mellitus in the ED. population in the region forms the major risk factor and might reflect the need for the implementation of preventive strategies.
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Affiliation(s)
- K. V. Prasad
- Ureology Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
| | - A. Al Ansari
- Ureology Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
| | - S. Al Kadhi
- Ureology Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
| | - E. F. El Malik
- Ureology Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
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48
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Abstract
In many forms of erectile dysfunction (ED), cardiovascular risk factors, in particular arterial hypertension, seem to be extremely common. While causes for ED are related to a broad spectrum of diseases, a generalized vascular process seems to be the underlying mechanism in many patients, which in a large portion of clinical cases involves endothelial dysfunction, ie, inadequate vasodilation in response to endothelium-dependent stimuli, both in the systemic vasculature and the penile arteries. Due to this close association of cardiovascular disease and ED, patients with ED should be evaluated as to whether they may suffer from cardiovascular risk factors including hypertension, cardiovascular disease or silent myocardial ischemia. On the other hand, cardiovascular patients, seeking treatment of ED, must be evaluated in order to decide whether treatment of ED or sexual activity can be recommended without significantly increased cardiac risk. The guideline from the first and second Princeton Consensus Conference may be applied in this context. While consequent treatment of cardiovascular risk factors should be accomplished in these patients, many antihypertensive drugs may worsen sexual function as a drug specific side-effect. Importantly, effective treatment for arterial hypertension should not be discontinued as hypertension itself may contribute to altered sexual functioning; to the contrary, alternative antihypertensive regimes should be administered with individually tailored drug regimes with minimal side-effects on sexual function. When phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil and vardenafil, are prescribed to hypertensive patients on antihypertensive drugs, these combinations of antihypertensive drugs and phosphodiesterase 5 are usually well tolerated, provided there is a baseline blood pressure of at least 90/60 mmHg. However, there are two exceptions: nitric oxide donors and α-adrenoceptor blockers. Any drug serving as a nitric oxide donor (nitrates) is absolutely contraindicated in combination with phosphodiesterase 5 inhibitors, due to significant, potentially life threatening hypotension. Also, α-adrenoceptor blockers, such as doxazosin, terazosin and tamsulosin, should only be combined with phosphodiesterase 5 inhibitors with special caution and close monitoring of blood pressure.
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Affiliation(s)
- Thorsten Reffelmann
- University of Southern California, The Heart Institute, Good Samaritan Hospital, Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA 90017-2395, USA
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Baldé NM, Diallo AB, Baldé MC, Kaké A, Diallo MM, Diallo MB, Maugendre D. [Erectile dysfunction and diabetes in Conakry (Guinea): frequency and clinical characteristics from 187 diabetic patients]. ANNALES D'ENDOCRINOLOGIE 2007; 67:338-42. [PMID: 17072239 DOI: 10.1016/s0003-4266(06)72608-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- N M Baldé
- Service d'Endocrinologie (Donka), CHU de Conakry, BP 909, Conakry, Guinée
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50
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Yang DH, Jeong JY, Jang SN, Lee SK, Choi YJ, Kim DH. Prevalence and Risk Factors for Erectile Dysfunction in Aging Men: Hallym Aging Study (HAS). Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.12.1258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Dong Hwan Yang
- Department of Urology, School of Medicine, Hallym University, Chunchon, Korea
| | - Jin Young Jeong
- Institute for Aging Studies, School of Medicine, Hallym University, Chunchon, Korea
| | - Soong Nang Jang
- Institute for Aging Studies, School of Medicine, Hallym University, Chunchon, Korea
| | - Sang Kon Lee
- Department of Urology, School of Medicine, Hallym University, Chunchon, Korea
| | - Yong Jun Choi
- Department of Social Medicine, School of Medicine, Hallym University, Chunchon, Korea
| | - Dong Hyun Kim
- Department of Social Medicine, School of Medicine, Hallym University, Chunchon, Korea
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