Prevalence of erectile dysfunction in Asian populations: a meta-analysis

Associations between organic erectile dysfunction and the risk of herpes zoster and postherpetic neuralgia in men

BACKGROUND

Whether erectile dysfunction (ED) leads to considerable stress for affected men remains unclear? In this study, we investigated whether organic ED (OED) is associated with increased risks of herpes zoster (HZ) and postherpetic neuralgia (PHN).

METHODS

A representative subset of Taiwan's National Health Insurance Research Database was employed for this study. Enrollees with OED from the years 2000 to 2018 were selected. To ensure comparability between the case and control groups, we implemented 1:1 propensity score matching based on age, index year, comorbidities, and medications.

RESULTS

The case group included 20,808 patients with OED, while the control group consisted of 20,808 individuals without OED. The OED group exhibited a significantly elevated risk of HZ (adjusted hazard ratio [aHR] = 1.74) and PHN (aHR = 1.56) compared to the non-OED group.

CONCLUSIONS

Men experiencing OED seem to face elevated risks of HZ and PHN compared to those without OED. ED may serve as a warning sign for individuals at HZ risk.

Effect of different physical activities on erectile dysfunction in adult men not receiving phosphodiesterase-5 inhibitors therapy: A systematic review and meta-analysis

BACKGROUND

Erectile dysfunction (ED) is prevalent not only among older males but also in younger. The physical activity has been considered a potential protective factor against ED. However, there is a lack of comprehensive research on the impact of exercise interventions specifically on ED patients.

OBJECTIVES

This study aimed to assess the effectiveness of the physical activity in addressing ED symptoms among adult males, without the use of the phosphodiesterase-5 inhibitors (PDE5i) therapy. Additionally, subgroup analysis was performed to evaluate the effects of different exercise modes.

METHODS

Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search. A registered protocol is available at PROSPERO (CRD42023441717). Our search spanned PubMed, Web of Science, Embase, and Cochrane Library, with data collection ending on 11 April 2024. The Cochrane Risk of Bias tool was applied by two independent authors to assess randomized controlled trial (RCT) quality. The primary endpoint was determined as the International Index of Erectile Function (IIEF) scores.

RESULTS

A total of seven RCTs were included. Utilizing a random-effects model, the estimated standardized mean difference (SMD) was 0.69 (95% confidence interval [CI] 0.37 to 1.02, p < 0.0001) for the overall impact of the physical activity. Subgroup analysis revealed SMDs of 0.81 (95% CI 0.56 to 1.06; p < 0.00001) for aerobic training alone. However, no significant improvement was observed with pelvic floor muscle training (PFMT) (SMD 0.03; 95% CI -0.68 to 0.75; p = 0.93) and a combination of aerobic and resistance training (SMD 0.84; 95% CI -0.41 to 2.09; p = 0.19) CONCLUSION: The findings of this study highlight a significant improvement in the erectile function following exercise interventions for adult men with ED, who are not receiving the PDE5i therapy, especially in conducting aerobic training alone. However, PFMT and a combination of aerobic and resistance training did not show significant improvements in erectile function from this study.

Sociodemographic and Clinical Profile of Patients Presenting With Erectile Dysfunction: Experience From a Tertiary Care Centre of North India

Background:

Erectile dysfunction (ED) is one of the most common psychosexual disorders in clinical practice, and it results in significant distress, interpersonal impairments, poor quality of life, and marital disharmony. However, there is limited research on ED in India. Therefore, this study aimed to assess the sociodemographic and clinical profile of patients presenting with ED.

Method:

Cross-sectional evaluation of patients with ED presenting to the psychosexual outpatient department (OPD) of psychiatry department in a tertiary care hospital was done on structured clinical pro forma, Mini-International Neuropsychiatric Interview, International Index of Erectile Function-5, Arizona Sexual Experience, Hamilton rating scale for depression, and Hamilton rating scale for anxiety.

Results:

The sample included 102 patients. The mean age was 33.38 years. The majority of the patients were married (81.4%), Hindu (82.4%), residing in a rural area (60.8%), and belonging to a nuclear family (62.7%). The majority of the patients had a moderate level of ED (50%) followed by mild-to-moderate ED (26.5%) and severe ED (23.5%). Premature ejaculation (46.1%) and depression (28.4%) were the most common sexual and psychiatric comorbidities. Obesity was common (62.7%), and only a minority had other metabolic dysfunction, namely dyslipidemia (7.8%), diabetes (5.9%), and hypertension (4.9%). Tobacco dependence and alcohol dependence were present in 37.3% and 6.9% cases, respectively.

Conclusion:

Young adults with moderate-to-severe ED were present for treatment at a tertiary center. Comorbidities of other sexual disorders, psychiatric disorders, and substance use are commonly encountered in such patients. Promotion of early help-seeking should be encouraged. Clinicians should thoroughly assess even the young patients for other sexual, psychiatric, and medical comorbidities.

Prevalence of erectile dysfunction in male survivors of cancer: a systematic review and meta-analysis of cross-sectional studies

Background

Prevalence of erectile dysfunction (ED) in male survivors of cancer across cancer types has not been systematically analysed.

Aim

To estimate the prevalence of ED in all types of cancer and identify characteristics associated with ED in survivors of cancer.

Design and setting

Systematic review and meta-analysis (MA) of cross-sectional studies.

Method

MEDLINE, CINAHL, PsycINFO, and EMBASE were searched, targeting reports published from inception to 1 February 2020. All retrospective or prospective studies reporting prevalence of ED in male patients with cancer and using a validated tool for detection of ED were included. A random-effects MA model was used to pool prevalence of ED as absolute estimates at three different stages, that is, ‘healthy’, ‘at diagnosis’, and ‘after treatment’. A univariate MA regression including the three-level group variable as the only independent variable was used to assess the difference in ED prevalence across the three groups. Further MAs were conducted for studies involving patients at diagnosis and after treatment, and statistical inferences were made with setting for multiple testing controlling for a false discovery rate (FDR) <0.05.

Results

In total, 1301 studies were assessed for inclusion. Of these, 141 were potentially eligible and subsequently scrutinised in full text. Finally, 43 studies were included with a total of 13 148 participants. Overall, pooled data of the included studies showed an ED prevalence of 40.72% (95% confidence interval [CI] = 31.80 to 50.29) in patients with cancer, with prevalences of 28.60% (95% CI = 12.10 to 53.83) at time of diagnosis and 42.70% (95% CI = 32.97 to 53.03) after treatment, with significant difference between these two stages and across cancer locations, controlling for an FDR <0.05.

Conclusion

Erectile dysfunction was particularly high in male survivors of cancer and was associated with cancer treatment, cancer site, and age.

Erectile dysfunction and its associated factors among the male population in Adigrat Town, Tigrai Region, Ethiopia: A cross-sectional study

BACKGROUND

Erectile dysfunction is one of the common sexual dysfunctions, but it is generally misunderstood as it is not a condition that threatens life. It affects an individual's physical as well as psychosocial health and has a significant impact on sufferers and their families' quality of life. No data are suggesting the prevalence of erectile dysfunction at the population level in Ethiopia. This research aimed to assess the prevalence and associated factors of erectile dysfunction among the male population.

METHODS

We employed a community based cross-sectional study among 802 study participants. A two-stage random sampling method was used for enrolling study participants. Including the International Index of Erectile Function Questionnaire-5 (IIEF-5) for erectile dysfunction, data were collected using pretested and a structured questionnaire administered by an interviewer. Binary logistic regression was performed to identify factors associated with erectile dysfunction.

RESULT

Out of the total of 802 individuals, 25.4%(95% CI:(22.4, 28.3%)) (n = 204) reported erectile dysfunction. The mean age of the participants was 34.3 ± 9.6 years. Age of 40years and above [AOR = 10.74, 95% CI: (7.07, 16.35)], physical inactivity [AOR = 3.62, 95% CI: (2.40, 5.45)], depression [AOR = 4.01, 95% CI: (2.22, 7.21)], poor quality of life [AOR = 1.59, 95% CI: (1.07, 2.36)] were significantly associated with erectile dysfunction.

CONCLUSIONS

In this study, the prevalence of erectile dysfunction was high. Therefore, it is recommended that erectile dysfunction treatment be integrated into the health care system that focuses on educating and inspiring people on healthy eating, physical activity, and behavior enhancing wellbeing.

Comparison of self-report and objective measures of male sexual dysfunction in a Japanese primary care setting: a cross-sectional, self-administered mixed methods survey

OBJECTIVES

Erectile dysfunction (ED) is a common problem among middle-aged males and men often do not talk about sexual problems with their primary care physicians (PCPs). We hypothesised that many Japanese men who meet the criteria for ED would not recognise their condition based on responses to an internationally validated scale. Our secondary aims were to examine potential barriers to seeking treatment for ED by their PCPs. We sought to elucidate their perspectives about male sexual dysfunction qualitatively. Through merging of the quantitative and qualitative findings, we sought an enhanced understanding of the factors affecting sexual dysfunction treatment.

DESIGN

A cross-sectional, self-administered mixed methods survey was distributed at a suburban family medicine clinic in Sapporo, Japan. Eligible participants were 40 to 69-year-old men who came for routine scheduled visits from 5 November to 21 December 2018. During the office visit, participants completed a confidential 11-item survey addressing sexual dysfunction including the 5-item version of the International Index of Erectile Function scale and open-ended questioning.

SETTING

Teine Family Medicine Clinic, a suburban family medicine clinic in Sapporo, Japan.

PARTICIPANTS

We enroled 66 male patients aged 40-69 years who presented for routine outpatient care in the Teine Family Medicine Clinic.

RESULTS

Of surveyed participants, 39% (26/66) reported having sexual dysfunction, but 92% (61/66) met ED criteria. Of respondents, 48% (16/33) had desire for treatment, but only one man had discussed sexual dysfunction with his PCP. Among the 12 desiring treatment from PCPs, the main barriers to discussing were shame (n=7) and lack of awareness that PCPs can treat ED (n=5). These men's perspectives about sexual dysfunction included viewing sexual dysfunction as normal ageing, attributing sexual dysfunction to decreased libido, considering sexual activity for a healthy life, having good rapport with PCPs, having incomplete knowledge about treatment and lacking an intimate relationship. Through a resulting model, the merged mixed methods findings illustrate how patient perceptions can reinforce or attenuate issues of awareness, desire for treatment and barriers to access.

CONCLUSIONS

In a Japanese primary care setting, the majority of participating male patients met ED criteria on an internationally validated measure, namely, the five-item version of the International Index of Erectile Function, but many were not aware of their ED. Misperceptions, lack of knowledge and personal factors are barriers to treatment. The mixed methods findings suggest misperceptions and personal attributes reinforce or attenuate awareness, preference for treatment and barriers to access. We conclude PCPs should routinely inquire about sexual dysfunction of men at risk and offer treatment to men who would benefit.

Evolution of the human pelvis and obstructed labor: new explanations of an old obstetrical dilemma

Without cesarean delivery, obstructed labor can result in maternal and fetal injuries or even death given a disproportion in size between the fetus and the maternal birth canal. The precise frequency of obstructed labor is difficult to estimate because of the widespread use of cesarean delivery for indications other than proven cephalopelvic disproportion, but it has been estimated that at least 1 million mothers per year are affected by this disorder worldwide. Why is the fit between the fetus and the maternal pelvis so tight? Why did evolution not lead to a greater safety margin, as in other primates? Here we review current research and suggest new hypotheses on the evolution of human childbirth and pelvic morphology. In 1960, Washburn suggested that this obstetrical dilemma arose because the human pelvis is an evolutionary compromise between two functions, bipedal gait and childbirth. However, recent biomechanical and kinematic studies indicate that pelvic width does not considerably affect the efficiency of bipedal gait and thus is unlikely to have constrained the evolution of a wider birth canal. Instead, bipedalism may have primarily constrained the flexibility of the pubic symphysis during pregnancy, which opens much wider in most mammals with large fetuses than in humans. We argue that the birth canal is mainly constrained by the trade-off between 2 pregnancy-related functions: while a narrow pelvis is disadvantageous for childbirth, it offers better support for the weight exerted by the viscera and the large human fetus during the long gestation period. We discuss the implications of this hypothesis for understanding pelvic floor dysfunction. Furthermore, we propose that selection for a narrow pelvis has also acted in males because of the role of pelvic floor musculature in erectile function. Finally, we review the cliff-edge model of obstetric selection to explain why evolution cannot completely eliminate cephalopelvic disproportion. This model also predicts that the regular application of life-saving cesarean delivery has evolutionarily increased rates of cephalopelvic disproportion already. We address how evolutionary models contribute to understanding and decision making in obstetrics and gynecology as well as in devising health care policies.

Physical activity as an adjunct treatment for erectile dysfunction

Increasing data are available to suggest that physical activity and lifestyle modification in general can benefit erectile function, with effect sizes comparable with established treatment options such as testosterone therapy and phosphodiesterase type 5 inhibitors. Despite this evidence, primary-care physicians are rarely afforded critical information on the underlying mechanisms through which physical activity works as a treatment, severely hampering treatment credibility for both physician and patient. Physical activity is associated with psychological and metabolic adaptations that are compatible with the adaptations required for the treatment of erectile dysfunction (ED). These adaptations include increased expression and activity of nitric oxide synthase, strengthened endothelial function, acute rises in testosterone, decreased stress and anxiety, and improved body image. Use of physical activity as a first-line treatment option for ED is limited, and explicit physical activity guidelines for the treatment of ED are required. Such guidelines should include not only a suggested exercise programme but also guidelines for physician-patient communication that might enhance patient receptivity and therapy continuation. An understanding of how physical activity affects erectile function, as well as its effectiveness in treating ED compared with other established treatments, can benefit urologists and primary-care physicians searching for noninvasive treatment options for men presenting with poor erectile function.

Erectile Dysfunction: An Umbrella Review of Meta-Analyses of Risk-Factors, Treatment, and Prevalence Outcomes

INTRODUCTION

Erectile dysfunction (ED) is a major health care problem that has implications for quality of life.

AIM

This umbrella review sought to synthesize all meta-analytic research on risk factors, treatment, and prevalence of ED.

METHODS

8 electronic databases were searched for relevant meta-analyses in June 2018. The evidence was graded with 2 measures that use quantitative criteria to establish the quality of report writing and confidence in the effect size reported.

MAIN OUTCOME MEASURES

Lifestyle factors, genetic markers, medical conditions, treatments.

RESULTS

In total, 98 meta-analyses were identified that included 421 meta-analytic effects, 4,188 primary-effects, and 3,971,122 participants. Pooled estimates showed that an unhealthy lifestyle, genetic markers, and medical conditions were associated with an increased risk of ED. Testosterone therapy and phosphodiesterase type 5 inhibitors showed the greatest treatment efficacy, with mild adverse events observed across treatments. Psychological and behavior change interventions produced effect sizes that were comparable to medication but had greater imprecision in effect sizes. There was little evidence that combined treatments were more efficacious than single treatments. Meta-analyses of prevalence estimates showed consistent age trends but were limited to particular regions or clinical samples, meaning that global estimates of ED are difficult to determine.

CLINICAL IMPLICATIONS

The umbrella review synthesized findings for many treatment options that might aid evidence-based clinical decision-making. Based on prevalence estimates, we recommend that primary care physicians take a proactive approach and enquire about erectile problems in all men over age 40 displaying any health-related issue (eg, overweight, cigarette smoking).

STRENGTHS & LIMITATIONS

Strengths include the calculation and comparison of summary estimates across multiple meta-analyses. Limitations include heterogeneity in research quality across research themes limiting effect size comparisons.

CONCLUSION

The review provides summary estimates for 37 risk factors and 28 treatments. Meta-analyses of risk factors often did not control for important confounders, and meta-analyses of randomized trials were not exclusive to double-blinded trials, active placebo controls, or tests of long-term effects. We recommend further meta-analyses that eliminate lower quality studies and further primary research on behavioral and combined treatments. Allen MS, Walter EE. Erectile Dysfunction: An Umbrella Review of Meta-Analyses of Risk-Factors, Treatment, and Prevalence Outcomes. J Sex Med 2019;16:531-541.

Degree of Planning of Sexual Intercourse Among Men From China, Japan, and Taiwan Taking Medication for Erectile Dysfunction: Findings of an Observational, Cross-Sectional Survey

INTRODUCTION

Management of erectile dysfunction (ED) is beset with assumptions around spontaneity of sexual intercourse, requiring candor between the physician and patient if appropriate treatment is to be implemented.

AIM

To evaluate the degree to which men who take ED medications plan for and have sex.

METHODS

Men from China, Japan, and Taiwan aged 40-70 years who had taken ED medications within the past 3 months were invited to participate anonymously in an online, self-administered survey that enquired about frequency and advance planning of sex, time between taking ED medication and intercourse, and treatment satisfaction. Data were analyzed using descriptive statistics.

MAIN OUTCOME MEASURE

Frequency of planning of sexual intercourse, planning and ED medication dosing interval, and frequency of ED medication use.

RESULTS

Data from 604 respondents (mean age 50.8 years) from China (n = 254), Japan (n = 250), and Taiwan (n = 100) were collected. Men used ED medications a median of ≤4 times per month in all 3 territories. 76% who used ED medication during the past 3 months planned for sex on specific occasions, with 59% and 52% agreeing that they plan for sex on specific days of the week and times of the day, respectively. Most commonly, men planned for sex up to several hours to a day beforehand, with 94% taking ED medication within 4 hours of sex. Satisfaction with ED medication was generally high and related to erection rigidity, speed of onset, and safety.

CONCLUSION

Knowledge of the degree to which individuals with ED plan for sex may have important implications for the appropriate prescription of ED medication. The high degree of planning around sexual activities exhibited by men taking ED medication suggests there is a need for appropriate counseling to ensure that treatment is aligned with patient behavior. Jiann B-P, Nakajima K, Dighe S, et al. Degree of planning of sexual intercourse among men from China, Japan, and Taiwan taking medication for erectile dysfunction: Findings of an observational, cross-sectional survey. Sex Med 2019;7:54-60.

Aphrodisiac Activity of Eulophia macrobulbon Extract on Erectile Dysfunction in Male Aged Rats

This study investigated the effect of Eulophia macrobulbon (EM) extract on sexual performance in aged-related erectile dysfunction (ED) rats. The ethanol EM extract at the doses of 15, 150, and 450 and sildenafil citrate at the dose of 5 mg/kg body weight (BW) were administered orally to the aged male rats once daily for 21 days. Mating parameters and intracavernosal pressure (ICP) were measured to evaluate their sexual and erection functions. Numbers of sperm and sperm motility as well as the diameter of seminiferous tubules were observed. The serum testosterone and 3',5'-cyclic guanosine monophosphate (cGMP) concentration in the rat penile tissue were analyzed. The results showed the significant increased sexual motivation, copulatory performance, and ICP of aged rats treated with sildenafil citrate and all doses of EM extract as compared to control aged rats. Moreover, their serum testosterone levels were slightly increased and significant increase in penile cGMP concentration was observed in these aged rats treated with sildenafil citrate and EM extract. The results suggest that treatment with EM could inhibit activity of PDE5 in penile tissue resulting in the increased cGMP level and bring to the improvement of erectile function and sexual performance.

Prevalence and predictors of erectile dysfunction in adult male outpatient clinic attendees in Johor, Malaysia

INTRODUCTION

Erectile dysfunction (ED) is a serious global burden that affects men as well as their partners. This study aimed to determine the prevalence and predictors of ED among male outpatient clinic attendees in Johor, Malaysia.

METHODS

We conducted a cross-sectional study of Malaysian men aged ≥ 18 years attending two major outpatient clinics in Johor Bahru and Segamat in Johor, Malaysia, between 1 January 2016 and 31 March 2016. Subjects were chosen via simple random sampling and 400 patients were recruited. The study instrument was a survey form that consisted of three sections: sociodemographic and comorbid profile, validated English and Malay versions of the 15-item International Index of Erectile Function, and the 21-item Depression Anxiety Stress Scale.

RESULTS

The overall prevalence of self-reported ED was 81.5%. The prevalence of ED according to severity was as follows: mild (17.0%), mild to moderate (23.8%), moderate (11.3%) and severe (29.5%). Multivariate analysis showed that ED was associated with increasing age (odds ratio [OR] 4.023, 95% confidence interval [CI] 1.633-9.913), Indian as compared to Malay ethnicity (OR 3.252, 95% CI 1.280-8.262), secondary as compared to tertiary education (OR 2.171, 95% CI 1.203-3.919), single as compared to married status (OR 6.119, 95% CI 2.542-14.734) and stress (OR 4.259, 95% CI 1.793-10.114).

CONCLUSION

ED has significant prevalence and severity among adult male outpatient clinic attendees in Johor. Increasing age, Indian ethnicity, lower educational level, singlehood and stress were significant predictors of ED.

Prevalence and Associated Factors of Erectile Dysfunction among Married Men in Vietnam

Background

Sexuality is an essential part of life; however, erectile dysfunction (ED) has been one of the most common complaints among men with sexual health issues all over the world. ED includes dysfunction in erection and penile erectile pain. In Vietnam, ED is a subject a not readily discussed. Thus, relatively little is known about ED among Vietnamese men.

Aims

To identify the prevalence of ED and its associated variables and the need for treatment of ED among married men in Vietnam.

Methods

This was a cross-sectional study. A total sample size included 746 married men, aged 20–60 years, living in four representative wards of the Hue City and randomly selected by systematic sampling methods. Respondents completed a self-reported questionnaire. The International Index of Erectile Function (IIEF-5) scale was used to determine ED severity, and the Depression Anxiety Stress Scales (DASS-21) was used to measure depression, anxiety, and stress. Quality of life was assessed using the WHO Quality of Life score (WHOQoL). A multivariate logistic regression model was used to determine the relationships between independent variables and ED.

Results

Mean age of married men was 44.3 ± 8.7. Two-thirds (66.9%) of respondents experienced ED symptoms. In terms of severity, 40.8% reported mild ED; 20.3% mild–moderate ED; 5.0% moderate ED; and 0.8% severe ED. Depression, anxiety, and stress problems were 5.0, 3.6, and 2.8%, respectively. One-third (33.1%) of the respondents reported having low quality of life, and 32.6% reported having medium quality of life. The vast majority (86.9%) had consensual sex with their wives/partners. Variables associated with increased IIEF-5 score were increased WHOQoL score, increased body mass index (BMI), religion, and no consumption of alcohol. Increasing age, disease history, increased anxiety, and no consensual sex with their wife/partner were associated with a lower IIEF-5 score. If experiencing ED, 55.5% would seek help from medical doctors, 55.1% discussed it with their wives/partners, and 23.1% turned to their friends for help.

Conclusion

The prevalence of ED was high, although only 5.8% experienced moderate to severe ED. The key factors associated with ED were age, religion, disease history, BMI, alcohol consumption, anxiety, quality of life, and consensual sex with their wives/partners. Sexual health education should be more specifically targeted for men, including the provision of local sexual health-care services for men.

Meta-Analysis of Prevalence of Erectile Dysfunction in Mainland China: Evidence Based on Epidemiological Surveys

Introduction

The epidemiologic characteristics of erectile dysfunction (ED) in mainland China remain incompletely understood.

Aim

To evaluate the overall prevalence and determine the severity of ED in mainland China.

Methods

An extensive database search was performed of PubMed, Embase, the Chinese National Knowledge Infrastructure (CNKI) database, the WanFang database, the Chinese Biological Medical Literature (CBM) database, and the Chongqing VIP using the following terms: erectile dysfunction, prevalence, epidemiology, epidemiological, and China. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Data were pooled for the random-effects model. Sensitivity analyses were conducted to assess potential bias.

Main Outcome Measures

All survey studies reporting on the prevalence of ED in mainland China were included. Data extraction was performed independently by two of the authors, and conflicts were resolved by another author.

Results

Of 2,155 retrieved articles, 25 were included in this meta-analysis with a total of 48,254 participants. The pooled prevalence of ED in men was 49.69% (95% CI = 39.29–60.10). The occurrence rates of ED in age groups younger than 30, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and at least 70 years were 20.86%, 25.30%, 40.48%, 60.12%, 79.10%, and 93.72%, respectively. The severity-specific prevalences of mild, moderate, and severe ED were 32.54%, 9.86%, and 13.97%, respectively. Moreover, the prevalences reported by different diagnostic methods were 14.19% for self-reports, 44.60% for the Chinese Index of Erectile Function, and 49.91% for the International Index of Erectile Function–5. The prevalence map based on a geographic information system showed an unequal geographic distribution.

Conclusion

ED is highly prevalent in mainland China, and its prevalence increases with age. More high-quality surveys on ED with larger samples throughout mainland China are needed to confirm these findings.

Increased risk of osteoporosis in patients with erectile dysfunction: A nationwide population-based cohort study

In this study, we aimed to investigate the risk of osteoporosis in patients with erectile dysfunction (ED) by analyzing data from the Taiwan National Health Insurance Research Database (NHIRD). From the Taiwan NHIRD, we analyzed data on 4460 patients aged ≥40 years diagnosed with ED between 1996 and 2010. In total, 17,480 age-matched patients without ED in a 1:4 ratio were randomly selected as the non-ED group. The relationship between ED and the risk of osteoporosis was estimated using Cox proportional hazard regression models. During the follow-up period, 264 patients with ED (5.92%) and 651 patients without ED (3.65%) developed osteoporosis. The overall incidence of osteoporosis was 3.04-fold higher in the ED group than in the non-ED group (9.74 vs 2.47 per 1000 person-years) after controlling for covariates. Compared with patients without ED, patients with psychogenic and organic ED were 3.19- and 3.03-fold more likely to develop osteoporosis. Our results indicate that patients with a history of ED, particularly younger men, had a high risk of osteoporosis. Patients with ED should be examined for bone mineral density, and men with osteoporosis should be evaluated for ED.

The SAD-MEN questionnaire: a new and reliable questionnaire for assessing sexual dysfunction in Asians with diabetes

AIM

The aim of this study is to construct a new tool for the assessment of sexual dysfunction among men with diabetes that is valid and reliable across different ethnicities, languages and socio-economic backgrounds in South East Asia.

METHODS

Focus group interviews were conducted to determine the construct of the questionnaire. Content and face validity were assessed by a panel of experts. A pilot study was conducted to validate the Sexual Dysfunction in Asian Men with Diabetes (SAD-MEN) questionnaire in English and Malay. The International Index of Erectile Function-5 (IIEF-5) was used for comparison. Construct validity was assessed using exploratory factor analysis, reliability was determined using Cronbach's α (> 0.700), and test-retest reliability using Spearman's rank correlation coefficient.

RESULTS

The SAD-MEN questionnaire yielded moderate face and content validity, with high reliability as shown by Cronbach's α values of 0.949 for sexual performance and 0.775 for sexual desire for the English version. The Malay language questionnaire had a Cronbach's α value of 0.945 for sexual performance and 0.750 for sexual desire. Test-retest reliability using Spearman's test gave correlation coefficients of r = 0.853, P = 0.000 for the English language questionnaire and r = 0.908, P = 0.000 for the Malay language questionnaire.

CONCLUSION

The SAD-MEN questionnaire is a valid and reliable tool by which to assess sexual dysfunction in English- and Malay-speaking Malaysian and South East Asian men with diabetes.

Prevalence, correlates, attitude and treatment seeking of erectile dysfunction among type 2 diabetic Chinese men attending primary care outpatient clinics

To investigate the prevalence, correlates, attitude and treatment seeking behavior of erectile dysfunction (ED) in type 2 diabetes mellitus (T2DM) patients in the primary care setting, a multi-center cross-sectional survey using a structured anonymous self-administered questionnaire was performed in 10 general outpatient clinics. Of the 603 subjects (91% response rate), the prevalence of ED men, as defined by the International Index of Erectile Function, was 79.1%. Most subjects had mild ED (28.9%), followed by mild-to-moderate ED (27.9%), then moderate ED (13.4%) and severe ED (9%). Nearly 55% of those with ED did not consider themselves as having ED. Less than 10% of them had ever sought medical treatment, although 76.1% of them wished to receive management from doctor(s) should they be diagnosed with ED. They considered the most important management from doctors to be clinical assessment (41.7%), followed by management of potential underlying cause (37.8%), referral to specialist (27.5%), education (23.9%), prescription of phosphodiesterase type 5 inhibitors (16.9%) and referral to counseling service (6.7%). The prevalence of ED was strongly associated with subjects who thought they had ED (odds ratio (OR) = 90.49 (20.00–409.48, P< 0.001)) and were from the older age group (OR = 1.043 (1.011–1.076, P = 0.008)). In conclusion, ED is highly prevalent among T2DM men. The majority of them wanted management from doctors should they have ED, but only a minority would actually voice out the request. Screening of ED among T2DM men using structural questionnaire allowed the diagnosis of more than half of the ED cases, which otherwise would have gone undiagnosed.

Lichen Simplex Chronicus Associated With Erectile Dysfunction: A Population-Based Retrospective Cohort Study

Background

An association between lichen simplex chronicus (LSC) and sexual dysfunction was explored. However, no data are available from investigations into the relationship between erectile dysfunction (ED) and LSC.

Objectives

This retrospective population-based cohort study aimed to clarify the risk of ED associated with LSC.

Methods

By using the Taiwan National Health Insurance Research dataset, we identified 5611 male patients who had been newly diagnosed with LSC from 2000 to 2004. The date of diagnosis was identified as the index date. LSC patients with incomplete demographic information or with a history of ED before the index date were excluded. In total, 22444 age-matched patients without LSC were randomly selected as the non-LSC group based on a 1:4 ratio. Subsequence occurrence of ED was measured until 2011. The association between LSC and the risk of developing ED was estimated using Cox proportional hazard regression model.

Results

After adjusting for age and comorbidities, patients with LSC had a 1.74-fold greater risk of developing ED compared with those without LSC (95% confidence interval=1.44–2.10). LSC patients with comorbidities including diabetes, hyperlipidemia, hypertension, cardiovascular disease, peripheral arterial disease, chronic obstructive pulmonary disease, chronic kidney disease, depression, and anxiety were at a higher risk of ED compared with the non-LSC patients without comorbidities.

Conclusions

LSC confers a greater risk in the development of ED. Physicians should be aware of the potential of ED occurrence in LSC patients.

Muslim prayer movements as an alternative therapy in the treatment of erectile dysfunction: a preliminary study

[Purpose] Our objective was to assess the effect of salat and mimicking salat movements and postures on subjects with erectile dysfunction. [Methods] Ten volunteers were recruited in this study. Subjects who were Muslims (Group I) were asked to perform their daily salat and a new intervention of an additional 12 movement cycles of salat for three sessions a week. Non-Muslim subjects (Group II) were taught to mimic salat movements, and were asked to perform a total of 12 movement cycles without reading the recitation for three sessions a week. An International Index for Erectile Function 5 (IIEF-5) questionnaire was given to the subjects before and after the intervention of performing salat or mimicking salat movements and postures. A nocturnal electrobioimpedance volume assessment (NEVA) device was used to measure the nocturnal penile tumescence (NPT) parameters over two consecutive nights. A nonparametric test was conducted to find the significant NPT parameters. [Results] The results showed that all measured parameters improved significantly, with the largest change observed in the maximum percent volumetric change over the baseline (from 138 to 222%). [Conclusion] This preliminary study suggests that the alternative approach of salat and mimicking salat movements and postures, may have beneficial effects for ED patients.

Influence of socio-demographic characteristics on prevalence of erectile dysfunction in Nigeria

Data on erectile dysfunction (ED) in Nigeria are limited. The study determined the influence of socio-demographic characteristics on ED prevalence in Ilorin, Nigeria. A sample of 399 married men aged 20-70 years was taken. They responded to a questionnaire adapted to reflect the local cultures. Data on socio-demographic characteristics, current use of penile erectile enhancers and erectile function were obtained. Erectile function was assessed using the abridged five-item version of the International Index of Erectile Function (IIEF-5). Presence of ED was defined as IIEF-5 score of <21. Descriptive and test statistics were applied to the quantitative data. The results revealed ED prevalence of 46.9% with 34.3, 9.8 and 2.8% having mild, moderate and severe ED, respectively. Men aged 40-64 years, reported severe ED from 9.1 to 36.4%. Yoruba ethnic group had the highest ED prevalence. Of the variables, age, length of marriage and spousal status were significantly associated and correlated with ED (P<0.05), while ethnicity, religion and age at first marriage were not (P>0.05). With an aging population, ED may become a significant health problem in similar environments in Nigeria.

Association of erectile dysfunction with atopic dermatitis: a population-based case-control study

INTRODUCTION

Some studies have highlighted the high prevalence of erectile dysfunction (ED) in patients with dermatological diseases such as psoriasis, chronic hand eczema, and systemic sclerosis. However, to date, there is still no study that has explored the relationship between ED and atopic dermatitis (AD).

AIM

Using a population-based data set, this case-control study aimed to examine the association of ED with prior AD by comparing the risk of prior AD between patients with ED and matched controls in Taiwan.

METHODS

This study used administrative claims data from the Taiwan National Health Insurance program. We identified 3,997 patients with newly diagnosed ED as cases and randomly selected 19,985 subjects without a history of ED as controls. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence interval (CI) for previously diagnosed AD between cases and controls.

MAIN OUTCOME MEASURE

The prevalence and risk of having been previously diagnosed with AD between cases and controls were calculated.

RESULTS

Of the 23,982 sampled subjects, 1,758 (7.3%) had been previously diagnosed with AD; it was found among 425 (10.6%) cases and among 1,333 (6.7%) controls (P<0.001). Conditional logistic regression analysis demonstrated that cases were more likely to have prior AD than controls (OR=1.60, 95% CI=1.42-1.80, P<0.001) after adjusting for monthly income, geographic location, urbanization level, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome.

CONCLUSIONS

There was an association between ED and prior AD. We suggest that clinicians should be more attentive to sexual complaints from patients with AD.

Factors associated with ejaculatory and orgasmic dysfunction in men with erectile dysfunction: analysis of clinical trials involving the phosphodiesterase type 5 inhibitor tadalafil

OBJECTIVE

To determine frequencies of, and risk factors for, ejaculatory dysfunction (EjD) and orgasmic dysfunction (OD) in men with different degrees of erectile dysfunction (ED).

PATIENTS AND METHODS

Baseline data from 28 ED trials were integrated and analysed. The International Index of Erectile Function Question 9 (IIEF-Q9; 'When you had sexual stimulation or intercourse, how often did you ejaculate?') and IIEF-Q10 ('How often did you have the feeling of orgasm with or without ejaculation?') were used to evaluate ejaculatory and orgasmic functions. Responses of 'almost never or never' or 'a few times (much less than half the time)' were taken as evidence of EjD or OD, respectively, whereas responses of 'almost always or always' or 'most times (much more than half the time)' were taken as evidence of normal function. Estimates of the relative risks (RRs) of EjD or OD were determined for multiple patient characteristics.

RESULTS

Among 12,130 study participants with available data, only 5117 (42.2%) reported normal ejaculatory function, and 4321 (35.6%) normal orgasm, regardless of ED severity. Among subjects with poor ejaculatory function, 16.7% had mild ED, and among subjects with poor sensation of orgasm, 21.9% had mild ED. Frequencies of EjD and OD increased with increasing ED severity. Of the 5117 individuals with normal ejaculatory function, 796 (15.6%) had poor sensation of orgasm. Of the 4321 subjects with normal orgasm, 226 (5.2%) had poor ejaculatory function. Men with (vs without) EjD or OD tended to be younger: 53.7 vs 56.9 years and 54.2 vs 56.2 years, respectively. Factors associated with increased RRs of EjD and OD included cardiomyopathy (RR for EjD 1.74; RR for OD 1.59); cardiac failure (RR 1.40; 1.22); and baseline use (or history of use) of antipsychotics (RR 1.45; 1.30), selective serotonin reuptake inhibitors (RR 1.31; 1.27), and tricyclic antidepressants (RR 1.34; 1.28).

CONCLUSIONS

EjD and OD occurred at baseline in more than one in three men enrolled in tadalafil trials. Even men with mild ED reported EjD or OD. Further studies are warranted to better understand the impacts of EjD and OD on male sexuality and quality of life.

Prevalence and medical management of erectile dysfunction in Asia

Erectile dysfunction (ED) is an important worldwide health issue that has a significant negative impact on the quality of life and life satisfaction of both the affected individual and his partner. Here we review the prevalence of ED in Asia, associated factors that may influence sexual attitudes and sexual behaviours, and randomized clinical trials (RCTs) of phosphodiesterase-5 (PDE-5) inhibitors to evaluate the clinical efficacy and safety of PDE-5 inhibitors in Asian men. We searched for English-language articles in MEDLINE and PubMed from January 2000 to September 2010. Our results showed that the overall reported prevalence rate of ED in Asia ranged widely, from 2% to 88%. This finding indicates that ED is a common and major health problem in this region. However, sociocultural and economic factors in Asia prevent people from seeking and obtaining appropriate medical care. We found reports on five kinds of PDE-5 inhibitors for the management of ED: sildenafil, vardenafil, tadalafil, udenafil and mirodenafil. The results of RCTs showed that these five PDE-5 inhibitors are more effective than placebo in improving erectile function in Asian men with ED and that these drugs have similar efficacy and safety profiles.

Prevalence and correlates of self-reported sexual dysfunction in CKD: a meta-analysis of observational studies

BACKGROUND

Sexual dysfunction is an under-recognized problem in men and women with chronic kidney disease (CKD). The prevalence, correlates, and predictors of this condition in patients with CKD have not been evaluated comprehensively.

STUDY DESIGN

Systematic review and meta-analysis.

SETTING & POPULATION

Patients treated using dialysis (dialysis patients), patients treated using transplant (transplant recipients), and patients with CKD not treated using dialysis or transplant (nondialysis nontransplant patients with CKD).

SELECTION CRITERIA FOR STUDIES

Observational studies conducted in patients with CKD only or including a control group without CKD.

PREDICTOR

Type of study population.

OUTCOMES

Sexual dysfunction in men and women with CKD using validated tools, such as the International Index of Erectile Function, the Female Sexual Function Index (FSFI), or other measures as reported by study investigators.

RESULTS

50 studies (8,343 patients) of variable size (range, 16-1,023 patients) were included in this review. Almost all studies explored sexual dysfunction in men and specifically erectile dysfunction. The summary estimate of erectile dysfunction in men with CKD was 70% (95% CI, 62%-77%; 21 studies, 4,389 patients). Differences in reported prevalence rates of erectile dysfunction between different studies were attributable primarily to age, study populations, and type of study tool used to assess the presence of erectile dysfunction. In women, the reported prevalence of sexual dysfunction was assessed in only 306 patients from 2 studies and ranged from 30%-80%. Compared with the general population, women with CKD had a significantly lower overall FSFI score (8 studies or subgroups, 407 patients; mean difference, -9.28; 95% CI, -12.92 to -5.64). Increasing age, diabetes mellitus, and depression consistently were found to correlate with sexual dysfunction in 20 individual studies of patients with CKD using different methods.

LIMITATIONS

Suboptimal and lack of uniform assessment of outcome measures.

CONCLUSIONS

Sexual dysfunction is highly prevalent in both men and women with CKD, especially among those on dialysis. Larger studies enrolling different ethnic groups, using validated study tools, and analyzing the influence of various factors on the development of sexual dysfunction are needed.

Sexual activity, erectile dysfunction and their correlates among 1,566 older Chinese men in Southern China

INTRODUCTION

Few studies on sexuality and its correlates in adults have been conducted in Asia; most studies in Asia have focused instead on erectile dysfunction in men rather than sexuality or sexual activities.

AIM

This study was conducted to evaluate the prevalence and factors associated with sexual activity and erectile dysfunction in elderly Chinese men aged 65 years and above.

MAIN OUTCOME MEASURES

Sexual activity and sexual functions were assessed using the International Index of Erectile Function-5. Depressive symptoms were measured by the Chinese version of the Geriatric Depression Scale. Lower urinary tract symptoms (LUTS) were measured by the International Prostatic Symptom Score.

METHODS

Cross-sectional data from a large prospective cohort study of Chinese elderly men were used in this study. A questionnaire that included demographic, lifestyle, and medical risk factors and physical examination were administered to 1566 Chinese men aged between 65 to 92 years in Hong Kong.

RESULTS

Only 30.7% of men were sexually active in the previous 6 months in this sample and among those who were sexually active, 88% had some form of erectile dysfunction. Being sexually inactive in the previous 6 months was associated with being older (odds ratio [OR] = 1.80; confidence interval [CI]: 1.56-2.09), single (OR = 1.87; CI = 1.19-2.94) and the presence of peripheral arterial disease (OR = 2.43; CI: 1.25-4.71). In multiple multinomial logistic regression, having clinically relevant depressive symptoms (OR = 3.37; CI: 1.31-8.70) and having moderate to severe LUTS (OR = 1.63; CI: 1.01-2.64) were independently associated with increased risk of having erectile dysfunction.

CONCLUSION

We showed that a large proportion of elderly men were not sexually active in Hong Kong. For those who were sexually active, most suffered from some degree of erectile dysfunction. Having clinically relevant depressive symptoms and LUTS were independently associated with increased risk of erectile dysfunction.

Prevalence and biopsychosocial correlates of erectile dysfunction in Hong Kong: a population-based study

OBJECTIVES

To describe the prevalence of erectile dysfunction (ED) in Hong Kong and identify the biopsychosocial correlates of ED.

METHODS

This was a descriptive and analytic population-representative cross-sectional study of ED in Hong Kong. The study subjects were 1506 men aged 26 to 70 years, recruited by two-stage stratified random sampling, and interviewed face-to-face by trained interviewers with structured questionnaires.

RESULTS

The overall prevalence of ED was 36.7% (95% confidence interval [CI] 33.7 to 39.7). The age-specific prevalence rate was 18.3% (95% CI 11.1% to 25.4%), 28.6% (95% CI 23.5% to 33.6%), 37.9% (95% CI 32.3% to 43.5%), 47.3% (95% CI 40.1% to 54.5%), and 61.1% (95% CI 51.1% to 71.0%) for the age groups 26 to 30, 31 to 40, 41 to 50, 51 to 60, and 61 to 70 years, respectively. The severity of ED increased with age (P <0.01), and sexual satisfaction decreased with age (P = 0.01). Age (odds ratio [OR] 1.26, P <0.01), living on Hong Kong Island (OR 0.71, P = 0.04), General Health Questionnaire score (OR 1.03, P <0.01), current smokers of 30 or more cigarettes per day (OR 2.11, P = 0.05), and hours spent on work, housework, and self-study (OR 0.945, P = 0.03) were independently associated with ED.

CONCLUSIONS

To our knowledge, this is the first population-representative study of ED in Hong Kong. The prevalence and severity of ED increased with age, and we found biological (age), psychological (General Health Questionnaire), and social (smoking, Hong Kong district, "hours spent on work") factors to have independent influences on ED. The negative association between "hours spent on work" and ED is a novel finding. The results of this study have shown that Hong Kong has a high prevalence of ED compared with Western populations.