The role of the sexual partner in managing erectile dysfunction

Global prevalence of erectile dysfunction and its associated risk factors among men with type 1 diabetes: a systematic review and meta-analysis

Various observational studies have examined the prevalence and determinants of erectile dysfunction (ED) in men with type 1 diabetes across different geographical areas. Nevertheless, a comprehensive systematic review and meta-analysis to consolidate the worldwide prevalence and risk factors remains lacking. Hence, the primary study objective was to perform an extensive systematic review and meta-analysis that specifically examined ED prevalence and determinants in men with type 1 diabetes. A thorough exploration was conducted by examining electronic databases, such as PubMed, Embase, and Web of Science. The general ED prevalence and a 95% confidence interval (CI) in men with type 1 diabetes were summarized. The relevant risk factors were analyzed by deriving a comprehensive odds ratio (OR) from merging the ORs using fixed- or random-effects models. The sources of heterogeneity were investigated using subgroup analyses and meta-regression. This systematic review and meta-analysis included 19 articles involving 3788 men with type 1 diabetes. The meta-analysis revealed that men with type 1 diabetes had a combined ED prevalence of 42.5% (95% CI: 34.3%-50.8%). This prevalence showed significant heterogeneity (I2 = 96.2%, P < 0.01). Meta-regression revealed that age (P = 0.016) and type 1 diabetes duration (P = 0.004) were significant causes of heterogeneity. Furthermore, the ED risk in men with type 1 diabetes was significantly influenced by age, type 1 diabetes duration, body mass index, glycated hemoglobin (HbA1c), retinopathy, and smoking habits (all P < 0.05). In summary, this systematic review and meta-analysis revealed a significant prevalence of ED in men with type 1 diabetes, highlighting the importance of clinicians addressing concerns regarding ED in this specific group of individuals.

Levels of elements in selected food substances that support usage in the management and treatment of erectile dysfunction

BACKGROUND

The use of fruits and vegetables for the management and treatment of erectile dysfunction has gained popularity due to the cheaper cost, accessibility and perceived absence of side effects. Much of the work done on plant-based aphrodisiacs has focused on the phytochemistry of secondary metabolites.

AIM

This work sought to analyze selected fruits and vegetables that are commonly used in the management of erectile dysfunction in Ghana and quantify the levels of some micro- and macro-elements necessary for good penile health in order to determine the usefulness or otherwise of the selected produce.

METHODS

Energy-dispersive X-ray fluorescence spectroscopy was used to detect and quantify the levels of potassium (K), calcium (Ca), selenium (Se), magnesium (Mg), iron (Fe), and zinc (Zn) in carrot roots, cucumber fruit, garlic bulb, ginger rhizome, nutmeg fruit, sweet potato tuber, tiger nut tuber and watermelon fruit.

RESULTS

The analysis revealed the presence of K, Ca, Mg, Fe and Zn. Levels of Se were below detection. The concentration of K was the highest in each of the food substances. However, in terms of recommended daily allowance, Mg had the highest contribution. Cucumber fruit and the rind of watermelon fruit had the highest levels of micro- and macro-elements implicated in erectile dysfunction.

CONCLUSION

The potential use of these foods to treat and manage erectile dysfunction may not only be due to the presence of phytochemicals alone but also the presence of significant levels of micro- and macro-elements required for good penile health.

The relationship between social support and erectile dysfunction in middle-aged and older males

Background

Erectile dysfunction (ED) is a prevalent condition that affects middle-aged and older men, impacting their sexual health and overall wellbeing. We aimed to investigate the relationship between social support and ED among this specific population.

Methods

Data were collected from the National Health and Nutrition Examination Survey. Social support was assessed through various dimensions, including emotional support, material support, and network support. Multivariate logistic regression was performed to examine the association between social support and ED, and a propensity-score-matched (PSM) analysis was further conducted.

Results

Among 1938 middle-aged and older males in the United States, 49.9% had a history of ED. ED was more prevalent in older individuals and those with comorbidities such as hypertension, prostate disease, higher serum creatinine level, and mental problems. Males with lower social support scores had a higher weighted rate of ED (P < 0.001). After adjusting for multiple variables in logistic regression analysis, a higher social support score was associated with a 19% lower likelihood of ED (weighted odds ratio [OR] 0.81, 95% confidence interval [CI] 0.66-0.98, P = 0.032). The association remained consistent after propensity score matching (OR 0.80, 95% CI 0.66-0.98, P = 0.028).

Conclusion

Social support appears to be associated with a reduced risk of ED in middle-aged and older men. Further research is needed to better understand this relationship and explore interventions that enhance social support, potentially leading to improved sexual health outcomes.

Global research trends in sexual health care: A bibliometric and visualized study

No Patient or Public Contribution, because the relevant data of this article comes from the literature database.

PURPOSE

The present study aimed to investigate the trends and research status of sexual healthcare.

METHODS

We searched the Web of Science database for relevant articles concerning sexual healthcare, published between 2009 and 31 December 2022. Data collected include: the number of publications, authors, journals, countries, institutions, keywords. VOSviewer and CiteSpace were used to conduct the bibliometric study and visualise the analysis.

RESULTS

A total of 1450 publications were included. The number of publications on sexual healthcare shows a fluctuating upward trend, and a stable core group of authors has been formed. The Journal of Clinical Nursing published the most articles on sexual healthcare (140 publications). The United States of America published the most articles (723, 49.86%). The research institution with the highest number of publications is the University of São Paulo. According to the keyword, timeline view and prominence mapping analysis, we believe that 'Female sexual health', 'HIV', 'LGBT' and 'Sexual Healthcare Services' may be new research hotspots in the field of sexual healthcare.

CONCLUSION

This study describes the research status of sexual healthcare research over the past 14 years. The findings of this study can provide helpful reference and guidance for the development trend and research direction of sexual healthcare.

Openness to Using an External Penile Prosthesis for Maintaining Sexual Intimacy by Individuals with Erectile Dysfunction: A Cross-Sectional Study

Introduction

Erectile dysfunction (ED) can lead to reduced sexual intimacy in men. The external penile prosthesis (EPP) is a device to help them participate in penetrative sex.

Aim

We investigate factors that may affect the willingness of individuals with ED to try an EPP and explore how the EPP could be presented most effectively to such patients to enhance their willingness to try an EPP.

Methods

Recruitment for this cross-sectional study occurred in-person and online. 147 participants (60.0 ± 14.3 years old; all experiencing self-reported ED) completed a survey containing both validated measures and questions specific to this study. The survey was open to English-speakers over the age of 18 who self-reported experiencing ED.

Main Outcome Measure

The primary outcome was participants’ willingness to try an EPP based on their level of knowledge about using the EPP. Secondary outcomes included the influence of the sexual function, sexual distress, ED history, age, relationship duration, sexual flexibility on willingness to try an EPP. We also collected feedback from participants’ on how and where they would like to be introduced to the EPP option.

Results

Most participants indicated a preference for being introduced to the EPP after trying some ED treatments (51.0%). Participants did not have strong preference regarding the setting where they were informed about the EPP. The majority however preferred having a sexual health therapist/counsellor (28.6%) or physician (25.9%) as the person introducing the EPP to them. Participants’ willingness to try the EPP increased with more information about the EPP presented to them (P < .001). Personalization of the EPP to match one's own penis was preferred by 38.7% of participants. Referring to this aid as an ‘external penile prosthesis’ was significantly more preferred over alternative labels, such as a “belted prosthetic phallus” or “strap-on dildo” (Ps < .001 for both). Multiple regression analyses showed that only sexual script flexibility was associated with the initial willingness to try an EPP (P < .01).

Clinical Implications

Clinicians should consider presenting the EPP to men with ED, who desire maintaining penetrative sexual intercourse with their partners.

Strength and Limitations

This is the first study to explore factors influencing the willingness to try an EPP. Further research is needed to establish the efficacy of EPPs for maintaining sexual activity and satisfaction in the real-life setting.

Conclusion

This study informs clinicians about effective ways to introduce the EPP to patients with ED who wish to maintain insertive/receptive sex.

Fu F, Duthie CJ, Wibowo E, et al. Openness to Using an External Penile Prosthesis for Maintaining Sexual Intimacy by Individuals with Erectile Dysfunction: A Cross-Sectional Study. Sex Med 2022;10:100559.

Erectile dysfunction: Is platelet-rich plasma the new frontier for treatment in patients with erectile dysfunction? A review of the existing evidence

Erectile dysfunction (ED) is one of the commonest disorders in adult males and affects 12–19% of men of reproductive age. Only few studies have evaluated the impact of ED on men and couples with infertility—these studies report higher rates of ED in this sub-group of men compared to the general population, with the prevalence of ED in men diagnosed with male infertility ranging from 6.7 to 61.6%. Nevertheless, ED is considered a rare cause of male infertility, accounting for about 0.4–5% of all causes of male infertility. ED remains a poorly treated condition globally and current therapies, like oral medication, offer only temporary symptomatic relief and do not influence disease progression—patients are potentially on lifelong treatment, with ED worsening over time. In contrast, regenerative medicine may potentially reverse or halt the progression of ED processes. In this article, we review the evidence for intracavernosal injections of platelet-rich plasma (PRP) in the treatment of ED.

The Efficacy of Acupuncture on Patients with Erectile Dysfunction: A Review

Erectile dysfunction (ED) is one of the most common sexual dysfunctions in men. The prevalence of ED has been increasing in recent years, which has critically affected male reproductive health and quality of life. According to various guidelines, phosphodiesterase-5 inhibitors are the most commonly recommended drugs for treating ED. However, many patients turn to alternative therapies because of adverse reactions, such as headache, and the poor efficacy of these drugs. Acupuncture is a long-established treatment in traditional Chinese medicine (TCM) and has been approved by the World Health Organization for improving penile erection as well as other discomforts in patients. However, previous systematic reviews have not discussed the characteristics and the related mechanisms of acupuncture treatment. Therefore, this study focuses on summarizing the characteristics and advantages of TCM in acupuncture treatment for ED based on relevant literature and on predicting and analyzing the related mechanisms.

Sexual function and sexual quality of life in men with genital warts: a cross-sectional study

BACKGROUND

Human papillomavirus is the most common sexually transmitted infection, usually passing from one person to another after the first sexual activity. Infection with this virus and the occurrence of genital warts (GWs) could have several effects on patients' health. This study was performed to evaluate the sexual function and sexual quality of life (SQOL) in men with GWs.

METHODS

This cross-sectional study was conducted from September 2019 to March 2020 with a sample size of 105 men with GWs in the dermatology clinic of Shahid Faghihi Hospital in Shiraz University of Medical Sciences, Iran. Data were collected using a demographic questionnaire, the International Index of Erectile Function (IIEF), and the Sexual Quality of Life-Men (SQOL-M) questionnaires and analyzed by descriptive and inferential tests with SPSS software version 22.

RESULTS

The mean score for overall sexual function in men was 48.50 ± 8.89. About 35.2% of men had overall sexual dysfunction (SD). The highest disorder rate was related to the erection domain (85.7%), and the lowest was related to the desire domain (5.7%). In the erection domain, most men (54.3%) experienced mild to moderate erectile dysfunction. The mean score for SQOL-M was 38.36 ± 14.47, and 56.2% of them had a good SQOL.

CONCLUSIONS

GWs affected men's erection more than the other sexual function domains. SD in men with GWs has a significant impact on their SQOL and ED was associated with impaired SQOL. Therefore, it is recommended to pay more attention to SD screening alongside SQOL assessment of men with GW.

Randomized Placebo Controlled Trial of Sildenafil Citrate, Cognitive Behavior Sex Therapy and Integrated Treatment in Men Diagnosed With Non Organic Erectile Dysfunction

Introduction

The integrated treatment combining phosphodiesterase-type 5 inhibitors (PDE5i) and Cognitive Behavior Sex Therapy (CBST) has been shown to yield promising results in the treatment of Non Organic Erectile Dysfunction (NOED) in young men.

Aim

The current study aimed to establish the efficacy of integrated treatment combining Sildenafil Citrate (SC) 50mg and CBST as a treatment of choice in young Pakistani men with NOED.

Methods

One hundred thirty-seven young men were recruited to participate in the study out of 164 men referred from sexual health clinics in Pakistan. They were randomized sequentially into 4 treatment groups namely SC = 35, CBST = 34, integrated treatment = 35, and placebo = 33. 7, 4, 6, and 4 men were dropped out of each treatment group respectively. The data of 116 men were analyzed. The on demand SC 50 mg, twice weekly 50 minutes sessions and home assignments, a combination of SC and 50 minutes sessions, and placebo were administered to firsst, second, third, and fourth group respectively for a period of 12 weeks. The follow-up assessment was done after 12 weeks of post-treatment for all groups.

Main Outcome Measures

The Urdu standardized versions of International Index of Erectile Functoning-5 (IIEF-5) and Depression Anxiety Stress Scale-21 (DASS-21) were the main outcome measures.

Results

The mixed repeated measures analysis of co-variance yielded significant impact of both CBST and integrated treatment groups in improving IIEF-5 scores at post treatment as compared to placebo. The CBST group experienced reduction in depression scores at post treatment as compared to both SC and integrated treatment. Only the integrated treatment brought reduction in anxiety scores at post treatment as compared to SC. The covariates age and NOED duration did not significantly impact the treatment outcome for all treatment groups.

Clinical Implications

The efficacy of integrated treatment approach for improving symptoms of NOED and associated depression and anxiety is strong clinical implication of the study.

Strengths & Limitations

The effectiveness of integrated treatment approach in the improvement of NOED symptoms and associated depression and anxiety scores is the main strength of the study. The improvement in depression scores is the added strength of CBST component of integrated treatment approach. The study should have included other PDE5i to compare their effects with the CBST or placebo groups.

Conclusion

The study concludes that the CBST and integrated treatments are treatment of choice for NOED and associated depression and anxiety in young men.

Bilal A, Abbasi NH. Randomized Placebo Controlled Trial of Sildenafil Citrate, Cognitive Behavior Sex Therapy and Integrated Treatment in Men Diagnosed With Non Organic Erectile Dysfunction. Sex Med 2022;10:100464.

A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM)

INTRODUCTION

Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far.

AIM

To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM).

METHOD

A comprehensive, narrative review of the literature was performed.

MAIN OUTCOME MEASURES

Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided.

RESULTS

A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable.

CONCLUSION

Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect. Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;9:100434.

Canadian Urological Association guideline: Erectile dysfunction

Erectile dysfunction (ED) impacts the wellness and quality of life of millions of Canadians. An evaluation focused on the identification of reversible and irreversible underlying factors is recommended for patients presenting with ED. Through a shared decision-making model framework, the goal of ED treatment is to improve functional outcomes and enhance sexual satisfaction while minimizing adverse effects associated with treatment. Given that ED is assessed and treated by multiple different types of health practitioners, the purpose of this guideline is to provide the best available evidence to facilitate care delivery through a Canadian lens. After a narrative review of ED assessment and treatment for general readership, five key clinical questions relating to priority areas of ED are assessed using the GRADE and evidence-to-decision-making frameworks.

Communication about physical activity to reduce vascular erectile dysfunction - A qualitative interview study among men in cardiac rehabilitation

BACKGROUND

Physical activity, a core intervention in cardiac rehabilitation, can reduce vascular erectile dysfunction (ED). ED is a common sensitive problem for men with cardiac diseases, decreasing their quality of life. Cardiac health professionals rarely provide information about ED or its relation to physical activity. Developing health professionals' communicative component of the complex intervention 'Physical Activity to reduce Vascular Erectile Dysfunction' (PAVED) is important. Understanding the receiver needs is essential in designing a complex intervention.

AIM

To elucidate men's perspectives on cardiac health professionals' communication about PAVED.

ETHICAL ISSUES

An Institutional Data Protection Agency approved the study.

METHODS

An interpretive data-driven thematic analysis was applied to individual, qualitative semi-structured interviews with 20 Danish men attending cardiac rehabilitation.

RESULTS

The men wanted health professionals' communicating about ED, as it was perceived as a major problem diminishing masculinity and tabooed by health professionals. Men wanted help for self-help, which may be possible with the aid of competent health professionals' communication about how to prevent, reduce and cope with ED - including information about PAVED. The men wanted health professionals' communication about ED in various contexts: general information in groups, sexual counselling for individuals and couples and written material.

STUDY LIMITATIONS

Recruitment was done from a Danish municipality's cardiac rehabilitation, and the transferability of the results may be limited to similar contexts.

CONCLUSION

Erectile dysfunction was experienced as a major biopsychosocial problem for the men and their partners. The men had a need for health professionals' communication about sexuality, ED and information about PAVED as well as about prevention, reduction and management of ED. The men had a need for professional communication about sexual health.

Couple Counseling and Pelvic Floor Muscle Training for Men Operated for Prostate Cancer and for Their Female Partners: Results From the Randomized ProCan Trial

Introduction

Patients with prostate cancer (PC) who undergo radical prostatectomy (RP) experience impaired sexual and urinary function.

Aim

To compare the effect of early couple counseling and pelvic floor muscle training (PFMT) with usual care for sexual and urinary dysfunction after RP.

Methods

The ProCan study was a randomized controlled trial (RCT) with two parallel treatment arms and 1:1 allocation. Between January 2016 and December 2017, candidates for RP were invited to a longitudinal questionnaire study and provided baseline measures before surgery. Patients who underwent RP, had a female partner, and were sexually active were invited to the ProCan RCT. Couples who provided informed consent were allocated to usual care or usual care and up to six couple counseling sessions, up to three instructions in PFMT and a video home-training program. All couples filled in follow-up questionnaires at 8 and 12 months and non-participants provided 12 months’ follow-up. Linear mixed-effect models and 95% confidence intervals were used to measure effects of the intervention.

Main Outcome Measure

Primary outcome was erectile function, measured with The International Index of Erectile Function, at 8 and 12 months follow-up. Secondary outcomes were sexual and urinary function and use of treatment for erectile dysfunction (ED) by patients; sexual function in female partners; and relationship function, health-related quality of life, anxiety, depression, and self-efficacy in both patients and female partners.

Results

Thirty-five couples were randomized. No significant effect of the intervention was found on erectile function at 8 months (estimated difference in change, 1.41; 95% CI; –5.51 ; 8.33) or 12 months (estimated difference in change, 0.53; 95% CI; –5.94; 6.99) or in secondary outcomes, except for significantly increased use of ED treatment at 8 months.

Conclusion

We found no effect of early couple counseling and PFMT, possibly because of the limited number of participants. Karlsen RV, Bidstrup PE, Giraldi A, et al. Couple Counseling and Pelvic Floor Muscle Training for Men Operated for Prostate Cancer and for Their Female Partners. Results From the Randomized ProCan Trial. Sex Med 2021;9:100350.

The Quality of Life and Economic Burden of Erectile Dysfunction

Erectile dysfunction (ED) is a common disorder in adult males that results in withdrawal from sexual intimacy, psychosocial problems (ie, poor self-esteem, depression, anxiety), decreased work productivity, and reduction in quality of life for both the men suffering from ED and their female partners. A pragmatic literature review was undertaken using PUBMED to identify original research studies published over the past 20 years that assessed the impact of ED on a male’s quality of life, the impact of ED on a female partner’s quality of life, or the economic impact of ED on employers. Twenty studies were selected for inclusion. This review showed that men with ED have a poorer quality of life than men without ED (n=9 studies). Results from a global burden of illness study showed that men with ED report substantially lower SF-36 Mental and Physical Component Summary scores and SF‐6D scores compared to men without ED (p<0.001). Similarly, the partner is also negatively impacted by ED due to relationship difficulties and decreased sexual satisfaction (n=8 studies). Results from the Female Experience of Men’s Attitudes to Life Events and Sexuality study showed that females were significantly less satisfied and engaged in sexual activity less frequently after their partner developed ED (p<0.001). ED also poses a substantial economic burden on employers (n=3 studies). An observational study in men aged 40–70 showed that men with ED had significantly higher rates of absenteeism (2x) and work productivity impairment compared to men without ED (p<0.001). Overall, this contemporary review demonstrated that ED imposes a substantial quality of life burden on men and their female partners as well as a significant economic burden on their employers. These findings underscore the need for more education and awareness of the burden of ED and greater access to appropriate ED treatments to help alleviate this burden.

A Preliminary Report on Quality of Life and Sexual Function in Brain Tumor Patients

BACKGROUND

As tumor treatment has advanced, patients are surviving and returning to productive lives. Quality of life (QoL) has become a significant consideration in the care of survivors. The 2005 Institute of Medicine Cancer Survivorship Care Planning requires the inclusion of information on the possible effects of cancer on marital/partner relationship and sexual functioning, among other factors related to QoL.

AIM

The purpose of this study is to explore the quality of life and the rates and types of sexual dysfunction among brain tumor patients.

METHODS

Patients were recruited from a neuro-oncology practice and given a QoL questionnaire (FACT-Br). Women were given the Female Sexual Function Index (FSFI). Men were given scales to assess premature ejaculation (PE), erectile dysfunction (ED), and Peyronie's disease. In addition, information about the site and type of tumor and treatment (surgery, radiation, chemotherapy) was collected. Descriptive statistics, as well as T-tests and ANOVAs, were used to analyze the data.

OUTCOMES

Study outcomes were obtained utilizing clinical cutoff scores for the sexual function questionnaires.

RESULTS

Data were collected on 50 patients. The most common form of brain tumor in this sample was glioblastoma. The frontal lobe was the most common location of tumors. There was significantly more sexual dysfunction than previously reported, with 66% of the sexually active women meeting the criteria for total FSFI. Of the men who were sexually active, 60% reported some ED, and 80% reported PE.

CLINICAL TRANSLATION

The current findings contribute to supporting the assertion that it is important for physicians to discuss with their cancer patients the issues related to sexual function.

STRENGTHS & LIMITATIONS

A primary strength of this study is the utilization of validated assessments of sexual function. The primary limitation is the sample size, particularly for men.

CONCLUSION

Our capacity to address the sexual function concerns of patients is dependent on our understanding of the types of difficulties encountered. This study contributes information about sexual function, a major contributor to QoL, in patients with brain tumor diagnosis and treatment. Boccia ML, Anyanda EI, Fonkem E. A Preliminary Report on Quality of Life and Sexual Function in Brain Tumor Patients. J Sex Med 2021;18:737-742.

Introducing sexual dysfunction in mental care

Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However,sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to SD assessment and intervention persist. Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management. Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What is more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency toward the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional's consideration for the sexuality of people experiencing mental disorders.

The impact of menopause on sexual function in women and their spouses

Background

The purpose of this study is to evaluate the impact of menopause on sexual function in women and their spouses.

Methods

This is a cross-sectional study that was conducted from January 2018 to May 2019 in Rasht (North of Iran). The participants included 215 menopausal women and their spouses. Data were collected using the demographic questionnaire, the Female Sexual Function Index (FSFI) questionnaire, and the International Index of Erectile Function (IIEF) questionnaire.

Results

On the basis of the FSFI and IIEF scores, 36.28% (78/215) women reported female sexual dysfunction (FSD) and 17.2% (37/215) men reported erectile dysfunction (ED) with 8.37% (N = 18) being mild, 5.58% (N = 12) mild to moderate, and 3.25% (N = 7) moderate ED. After adjusting differences in the female age distribution, the total score and scores of the IIEF subscales were also not significantly lower in the spouses of women with FSD than women without FSD.

Conclusion

Although, significant correlations between male erectile function and menopausal female sexual function have not identified; but, low scores of the subscales of FSFI in female participants mostly impaired sexual satisfaction and overall satisfaction in their spouses.

The Use of Delphi Method and Analytical Hierarchy Process in the Establishment of Assessment Tools in Premature Ejaculation: The Scoring System for Premature Ejaculation Treatment Outcomes

There is a lack of objective tools to comprehensively evaluate premature ejaculation (PE) treatment results clinically. We aimed to describe the development of a novel scoring system for PE treatment results as an example of using the Delphi method and an analytical hierarchy process for complex decision-making in the field of sexual medicine. A Delphi question survey was adopted to collect expert opinions from 47 Chinese specialists in andrology/urology on the assessment of PE treatment outcomes based on four primary properties, that is, the improvement in intravaginal ejaculation latency time, a couple’s mental status, the ability to control ejaculation, and sexual intercourse satisfaction. Different weights on those primary properties were assigned to create a mathematical hierarchy matrix and then perform an analysis. The scores were assigned according to the calculated weights. The ratio among the combined weights of the four primary properties was 1:3:2:3. The total numerical score was 36. Scores above 27, between 26 and 18, and below 17 indicated significant improvement, moderate improvement, and no improvement in PE, respectively, with selected treatments. The scoring system with 36 points can be used by physicians, patients, and their sexual partners to comprehensively and objectively assess quantitative PE treatment results.

Developing a prediction model for the self-evaluation of erectile dysfunction in an adult male population

The purpose of this study was to develop an erectile dysfunction (ED) risk assessment tool suitable for the general population. Based on an ED network survey of the general adult male population in China from October to November 2019, a total of 612 cases with a mean age of 31 years (interquartile range: 28-37) with valid data were collected: 357 cases were assigned to the training set and 255 to the validation set. The ED risk prediction model was established by multifactor logistic regression analysis, and nomograms were constructed for visualisation. In the validation set, a receiver operating characteristic curve, calibration curve analysis and decision curve analysis were used to evaluate the discrimination, calibration and clinical usefulness of the ED risk prediction model. Based on multivariate logistic regression, education, smoking, chronic diseases, feelings about one's spouse, frequency of sexual intercourse, masturbation and self-reported sexual satisfaction were selected as predictors to develop the ED prediction model. The model had good discrimination, calibration and clinical applicability. The ED risk prediction model developed in this study can effectively predict ED risk in the general population.

Practical Approaches to Treat ED in PDE5i Nonresponders

Erectile dysfunction (ED) is a common sexual disorder in adult males and one of the most important factors affecting their quality of life and that of their partners. Although PDE5 inhibitors (PDE5is) are the first choice for improving erectile function, there is a substantial proportion of ED patients, termed PDE5i nonresponders, who do not respond to PDE5is. Because of the lack of effective therapies, these patients always have serious social and psychological problems due to ED, which should be addressed. Here, we review the available literature about ED and PDE5is and propose several strategies for mitigating ED in PDE5i nonresponders.

Different Evaluations Exist between Men with Erectile Dysfunction and Their Female Partners When Using Erectile Hardness Model: An Interesting, Observational, and Cross-Sectional Field Survey

It is an interesting clinical phenomenon that when evaluating the erectile function of men with erectile dysfunction by couples, respectively, using the erectile hardness model, there will exist the evaluation difference between men and their female partners. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. To explore the influencing factors associated with this clinical phenomenon, we conducted this interesting, observational, and cross-sectional field survey. We enrolled 385 couples from the andrology clinics of the first affiliated hospital of Anhui Medical University from December 2017 to December 2018. The demographic data of couples, the medical history, sexuality and the characteristics of ED, and anxiety and depression of the couples were collected through face-to-face interview and questionnaires. The couples were divided into two groups containing 238 couples and 147 couples, respectively. We divided couples into difference group including couples which have inconsistent evaluation results from touching the erectile hardness model and no difference group including couples which have consistent evaluation results from touching the erectile hardness model, respectively. The difference group where the couples share different evaluation results reported higher erectile hardness grade from men than from their female partners (male > female: 73.11% vs. male < female: 26.89%). The scores of IIEF-5 in difference group and no difference group are 13.43 ± 5.75 and 16.82 ± 8.23, respectively. The average grades evaluated from men and women in difference group are 2.79 ± 0.85 and 2.45 ± 0.63, respectively. The average grades evaluated from couples in no difference group are 3.02 ± 0.45. Through statistical comparison and logistic regression analysis, duration of ED > 16 months, seeking treatment from female, negative communication state, and depression from men are the relevant factors accounting for the different evaluation results. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. As for couples with these risk factors, we cannot focus only on the oral medication which only restores the penile erectile function. More importantly, we must combine the sexual counseling and sexual knowledge education with the drug treatment. When the two treatments are tightly integrated, not only the penile erection but also the gap of couples can be restored which is the best result of the ED treatment.

Effect of estradiol on penile erection: a cross-sectional study

Background

Past studies have shown that elevated estradiol levels could inhibit penile erection, but the relationship between estradiol and erection of the penile tip or base has not been extensively researched.

Methods

We therefore investigated estradiol's effects on the erection of the penile tip and base, with a cross-sectional study of 135 patients with erectile dysfunction (ED), based on scores of ≤21 according to the International Index of Erectile Function-5. All patients were tested for nocturnal penile tumescence, blood pressure (BP), serum glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), progesterone (P), estradiol (E), and testosterone (T). Univariate and multivariate analyses were used to assess associations between estradiol levels and erection at the penile tip and base.

Results

We found no obvious relationship between erection time at penile tip and estradiol levels but did observe a negative correlation between base erection time and estradiol level [hazard ratio (HR): ‒0.11; 95% CI: ‒0.80-1.72]. With increasing estradiol concentration, multivariate analysis showed an obvious reduction in base erection time among patients with normal Rigiscan results (HR: ‒0.31; 95% CI: ‒1.63-1.29) (P<0.05) as estradiol concentration increased.

Conclusions

Our data indicate that estradiol inhibits penile erection, particularly at the penile base. Also, when the effective erection time of the penile base lasts longer than 10 min, estradiol has a more obvious inhibitory effect on penile base erection.

[Penile prostheses: Description of a series of implants with and without dilatation of the corpora cavernosa]

INTRODUCTION

Penile prosthesis (PP) implantation is the treatment of choice for refractory erectile dysfunction (ED). They show a high satisfaction rate (75%-100%) and a complication rate that varies between 2.1% and 28.8%. The standard surgical technique includes dilatation of the corpora cavernosa (CC) prior to the insertion of the cylinders. This step takes time and is critical for the occurrence of complications. The aim of this study is to describe the results of a series of PP implanted using the techniques with and without dilatation of the CC.

MATERIALS AND METHODS

One-hundred and 20 patients with refractory ED in whom a PP was implanted by 2 surgeons in different centers. Comorbidities, operative characteristics, satisfaction and postoperative complications were evaluated.

RESULTS

The average age was 61±9.6 years. The most prevalent comorbidities were: history of radical prostatectomy, high-blood pressure and diabetes mellitus. Forty-two malleable and 78 hydraulic prostheses were implanted. Eleven patients had a previous PP. The median operative time was 70minutes (35-140). The satisfaction reported was 95.8%. Ten patients presented complications. In the group in which the surgery was performed without dilatation of the CC (n=80), the operative time was shorter (62.5minutes [35-105] versus 90minutes [60-140] respectively, p<0.0001). There was no difference in complications (p=0.73) or levels of satisfaction (p=0.196) when comparing the technique with and without dilatation of the CC.

CONCLUSION

In our series, a shorter operative time was observed with the technique without dilatation of the CC, but there were no differences in complications. A prospective and randomized study is required to make a stronger recommendation regarding to dilatation of the CC.

Mindfulness-Based Group Therapy for Men With Situational Erectile Dysfunction: A Mixed-Methods Feasibility Analysis and Pilot Study

INTRODUCTION

Recent advances in sexual health research support the benefits of mindfulness-based therapy (non-judgmental present-moment awareness) for the treatment of women's sexual dysfunction.

AIM

To determine whether it is feasible to implement an adapted, empirically supported treatment protocol for female sexual dysfunction to the specific needs of men with situational erectile dysfunction (ED).

METHODS

A mixed-methods approach was taken for this feasibility pilot study. A total of 10 men (M_age = 40.3, SD = 14.01, Range = 20-67) with a diagnosis of situational ED were recruited to participate in a 4-week mindfulness-based treatment group. The group was adapted from protocols shown to be effective for women with sexual dysfunction and edited to include content specific to situational ED. Sessions were 2.25 hours in length, included daily home-practice activities, and integrated elements of psychoeducation, sex therapy, and mindfulness skills. Men completed questionnaires (International Index of Erectile Functioning, Relationship Assessment Scale, Five Facets of Mindfulness Questionnaire, a treatment expectation questionnaire) at 3 time points (prior to treatment, immediately after treatment, and 6 months after treatment). 5 men (M_age = 44.4, SD = 15.76, Range = 30-67) participated in qualitative exit interviews.

MAIN OUTCOME MEASURE

Findings support the feasibility of adapting a mindfulness-based group treatment for situational ED.

RESULTS

With respect to feasibility, the dropout rate was 10%, with 1 participant who did not complete the treatment. Comparisons between Time 1 and Time 3 self-reports suggested that this treatment protocol holds promise as a novel means of impacting erectile functioning (Cohen's d = 0.63), overall sexual satisfaction (Cohen's d = 1.02), and non-judgmental observation of one's experience (Cohen's d = 0.52). Participants' expectations for the treatment were generally positive and correlated to self-reported outcomes (r = .68-.73). Qualitative analyses revealed 6 themes: normalization, group magic, identification of effective treatment targets, increased self-efficacy, relationship factors, and treatment barriers.

CLINICAL IMPLICATIONS

In a shift toward a biopsychosocial framework for the treatment of men's sexual dysfunction, clinicians may consider incorporating mindfulness to address psychosocial and psychosexual components of dysfunction.

STRENGTH & LIMITATIONS

This is the first study-to our knowledge-to adapt mindfulness protocols for use with men's sexual dysfunction. Because this is a pilot study aimed at feasibility, the sample size is small and no control group was included, thus conclusions about efficacy and generalizability cannot be made.

CONCLUSION

The current study suggests that a mindfulness group therapy framework offers a feasible and potentially promising treatment avenue for men with situational ED. Bossio JA, Basson R, Driscoll M, et al. Mindfulness-based group therapy for men with situational erectile dysfunction: A mixed-methods feasibility analysis and pilot study. J Sex Med 2018;15:1478-1490.

The corpus cavernosum after treatment with dutasteride or finasteride: A histomorphometric study in a benign prostatic hyperplasia rodent model

Erectile dysfunction is a common side effect of finasteride and dutasteride treatments. The objective of this study was to investigate the structural changes in the penis using a benign prostatic hyperplasia (BPH) rodent model treated with dutasteride or finasteride. Sixty male rats were divided into the following groups: C, untreated control rats; C + D, control rats receiving dutasteride; C + F, control rats receiving finasteride; H, untreated spontaneously hypertensive rats (SHRs); H + D, SHRs treated with dutasteride; and H + F, SHRs treated with finasteride. Treatments were performed for 40 days, and penises were collected immediately thereafter. The organs were analyzed using histomorphometric methods to determine the cross-sectional penile area, as well as the surface density (Sv) of smooth muscle fibers, connective tissue, elastic system fibers, and sinusoidal spaces of the corpus cavernosum. The results were compared using a one-way ANOVA with Bonferroni's posttest. Groups C + D and C + F had a significantly smaller penile cross-sectional area, but more elastic system fiber Sv compared to Group C. Group C + D showed less smooth muscle Sv, and Group H showed more connective tissue but a smaller sinusoidal space Sv in the corpus cavernosum compared to Group C. Groups H + D and H + F had less smooth muscle Sv than Group H. Group H + D also had more connective tissue and elastic system fiber Sv than Group H. Both dutasteride and finasteride promoted penile modifications in the control rat penis, although this affect was greater in Group H animals. In this rodent model, dutasteride was the drug that most affected the corpus cavernosum.

Cancer Survivorship in Adults

With the favorable trend regarding survival of cancer in the Western world, there is an increasing focus among patients, clinicians, researchers, and politicians regarding cancer survivors' health and well-being. The number of survivors grows rapidly, and more than 3% of the adult populations in Western countries have survived cancer for 5 years or more. Cancer survivors are at increased risk for a variety of late effects after treatment, some life-threatening such as secondary cancer and cardiac diseases, while others mainly have negative impact on daily functioning and health-related quality of life (HRQOL). The latter factors include fatigue, anxiety disorders, sexual problems, insomnia, and reduced work ability, while depression does not seem to be more common among survivors than in the general population. Life style factors are highly relevant for cancer survivors concerning risk of relapse and somatic comorbidity. The field of cancer survivorship research has grown rapidly. How to best integrate the knowledge of the field into clinical practice with adequate follow-up of cancer survivors at risk for developing late effects, is still an unresolved question, although several models are under consideration.

Predictors of Patient and Partner Satisfaction Following Radical Prostatectomy

INTRODUCTION

The diagnosis and treatment of prostate cancer adversely affects the physical and emotional well-being of patients and partners and has been associated with sexual dysfunction in patients and their intimate partners.

AIM

To identify predictors of sexual satisfaction in prostate cancer survivors and their partners based on a review of the current literature.

METHODS

We performed a comprehensive review of the PubMed database from January 2000 to May 2017 focused on the (i) prevalence of patient and partner sexual dysfunction related to radical prostatectomy, (ii) differences in patient and partner perspectives of sexual function and dysfunction, and (iii) predictors of patient and partner sexual satisfaction after radical prostatectomy.

MAIN OUTCOME MEASURES

Patient- and partner-reported sexual satisfaction.

RESULTS

There is a paucity of published data examining sexual satisfaction in prostate cancer survivors and their partners. Patients and partners can have different expectations of sexual outcomes after radical prostatectomy and different attitudes toward the relative importance of recovery of sexual function after surgery. Available data suggest that patients' and partners' mental and physical health and the quality of communication between them are important contributors to their sexual satisfaction. Patient-perceived partner support also is associated with better patient-reported erectile function and greater relationship satisfaction.

CONCLUSION

Mental health, physical health, quality of interpersonal communication, and patient-perceived partner support appear to be the most important predictors of sexual satisfaction for patients and partners in the post-prostatectomy period. There is a definite need for further research on this topic to develop interventions to improve sexual function and quality of life for prostate cancer survivors and their intimate partners. Guercio C, Mehta A. Predictors of Patient and Partner Satisfaction Following Radical Prostatectomy. Sex Med Rev 2018;6:295-301.

Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction

Erectile dysfunction (ED), the most commonly reported sexual problem for men, reduces the quality of life for both patients and their partners. Even when physiologically effective, long-term adherence to ED treatments is poor. We review here the implication of having patients' partners involved in ED treatment, starting with treatment selection. We suggest that having partners engaged from the outset may promote an erotic association of the treatment with the partner, i.e., conceptually linking the aid to the sexual pleasure that the partner provides. We hypothesize that this erotic association should enhance the sexual aid's effectiveness and might potentially help improve long-term adherence. The primary focus of this review, though, is non-pharmacological and non-surgical options for maintaining sexual activity for men with ED. Though not ED treatments per se, anecdotal data suggest that these options may be effective for some patients and their partners in regaining a satisfying sex life. The aids discussed include external penile prostheses, penile sleeves, and penile support devices. These devices can allow men to participate in penetrative sexual intercourse despite moderate to severe ED. External penile prostheses can be personalized so they match in size and shape a man's normal full erection. Penile sleeves can similarly be customized with a lumen that fits best a patient's penis for optimal tactile stimulation. We review how multi-sensory integration can enhance sexual arousal for men who use such devices, allowing them to achieve orgasm despite intractable ED. Patients are not always advised within ED clinics about these options nor why and how they can facilitate non-erection dependent sexual recovery. Clinicians need to be aware of these devices and their positive attributes, so they can objectively counsel and encourage couples to explore their use as an alternative to more invasive treatments. The most commonly promoted non-medical ED aid offered to patients is the vacuum erection device. We discuss how erections achieved with the vacuum erection device have a "hinge effect", that is an underappreciated barrier to the effectiveness of the erection. With a hinged erection, the penis points downward rather than upward. We show how the normal kinematics of the penis during coitus is not strictly linear (i.e., not uniaxial; not just in-and-out), and is impeded by hinging. Positional adjustment, such as the receptive partner being on top, may help overcome this problem for some couples. Lastly, we suggest that, in the case where ED can be anticipated from a pending medical treatment, such as a prostatectomy, pre-habilitative approaches may potentially improve adherence to sexual aid use in the long-term. In conclusion, non-pharmacological and non-surgical options for sexual recovery are available. Scientific studies on the effectiveness of these interventions in restoring satisfying sex are warranted.

Erectile Dysfunction Symptoms in Polydrug Dependents Seeking Treatment

OBJECTIVE

To assess erectile dysfunction (ED) symptom prevalence, sexual behavior conditions, and risk factors associated to ED in a male polydrug dependent sample.

METHODS

A cross-sectional design study was conducted with 102 substance-dependent male polydrug users who sought outpatient treatment in São Paulo, Brazil. Sociodemographic data, drug of choice, chronic disease questions, sexually transmitted infections, International Index of Erectile Function (IIEF) scale, Sexual Addiction Screening Test (SAST), and WHOQOL-Bref instrument were used.

RESULTS

The erectile dysfunction prevalence was 32.3% and it was related to the marital status (single) (p < 0.001), occupational status (fully unemployed) (p < 0.001), presenting a chronic disease (p = 0.027), and with types of sexual partnerships (occasional partner) (p < 0.001). Alcohol (73.5%), tobacco (79.4%), cannabis (83.3%), and cocaine (snorted 78.4% and smoked 42.2%) were the drugs of choice. The ED risk decreased when marital status was married (odds ratio = 3.2 CI95% 1.411-7.518) and with chronic disease (odds ratio 0.06 CI95% 0.00-0.97), while having occasional sexual partners increased 14 times ED risk (OR 14.0 CI95%1.62-122.18). There were no significant associations between quality of life, DOC and ED.

CONCLUSION

Approximately one third of the substance dependents in this sample presented ED. There is a need to integrate psychiatric and clinical care in substance treatment services, and to improve the provision of sexual health care and support available for this population.