Aging and sexual response in the laboratory in patients with erectile dysfunction

The effects of common medications on volumetric phallometry

Phallometry is a physiological measure of sexual response widely used for the assessment of paedophilia among sexual offenders. Although many medications decrease penile response sufficiently to interfere with sexual intercourse, it is unknown to what extent such medications might interfere with phallometric testing. In the current study, we utilized a naturalistic convenience sample of 1078 men who attended a clinic for assessment of sexual preferences, mostly related to sexual offence convictions. In the present analyses, we quantified the differences in penile response during phallometric assessment associated with taking a range of common medications. Participants on medication typically showed less penile output than participants not taking medications; however, differences were largely accounted for by age rather than by medication status. Though most medications were associated with decreases in penile responsivity during volumetric phallometric testing, such changes were small in absolute terms and appeared to be associated with ageing rather than with the medications themselves.

Toward a new 'EPOCH': optimising treatment outcomes with phosphodiesterase type 5 inhibitors for erectile dysfunction

Despite the marked adverse impacts of erectile dysfunction (ED) on quality of life and well-being, many patients (and/or their partners) do not seek medical attention for this problem, do not receive treatment or discontinue such treatment even when it has effectively restored erectile responses to sexual stimulation. Phosphodiesterase type 5 (PDE5) inhibitors are considered first-line therapies for men with ED. To help physicians maximise the likelihood of treatment success with these agents, we conducted an English-language PubMed search of articles involving approved PDE5 inhibitors dating from 1 January 1998 (the year in which sildenafil citrate was introduced), through 31 August 2008. In addition to sildenafil, tadalafil and vardenafil, search terms included 'adhere*', 'couple*', 'effect*', 'effic*', 'partner*', 'satisf*', 'succe*' and 'treatment outcome.' Based on our analysis, physician activities to promote favourable treatment outcomes may be captured under the mnemonic 'EPOCH': (i) Evaluating and educating patients and partners to ensure realistic expectations of therapy; (ii) Prescribing a treatment individualised to the couple's lifestyle needs and other preferences; (iii) Optimising treatment outcomes by scheduling follow-up visits with the patient to 'fine-tune' dosages and revisit key educational messages; (iv) Controlling comorbidities via lifestyle counselling, medications and/or referrals and (v) Helping patients and their partners to meet their health and psychosocial needs, potentially referring them to a specialist for other forms of therapy if they are not satisfied with PDE5 inhibitors.

Effects of sexual arousal on vibrotactile detection thresholds in aged men with and without erectile dysfunction

BACKGROUND

Erectile dysfunction (ED) is a common problem in ageing men. Abnormalities in sexual arousal may contribute to its development, and to the failure of pharmacological therapies. However, there are few objective ways of assessing arousal. Sexual arousal has been shown to affect vibrotactile detection thresholds (VDT) in young, healthy men. The present study assessed the effects of sexual arousal on VDT in middle-aged men with and without ED in order to determine whether differences exist between the groups and if such differences may be useful in the evaluation of ED.

METHODS

VDT in the right index finger of 15 heterosexual men (mean age 74.3 +/- 6.0 years) who had been formally diagnosed with ED (ED group) and 16 men (mean age 68.0 +/- 6.6 years) who reported no sexual dysfunction in the past 6 months (erectile function (EF) group) were measured before and after watching erotic and control videos using a forced-choice, staircase method at frequencies of 30, 60 and 100 Hz. A mechanical stimulator was used to produce the vibratory stimulus. Results were analysed using repeated-measures analysis of variance.

RESULTS

There was no significant effect of watching the erotic video on VDT in subjects in the ED group. In the EF group, VDT was significantly lower at 60 and 100 Hz after watching the erotic video. There was no change in VDT after watching the control video in either group.

CONCLUSION

In response to sexual arousal, VDT in ageing men with normal erectile function decrease, whereas VDT in ageing men with ED remain unchanged.

Tadalafil is efficacious and well tolerated in the treatment of erectile dysfunction (ED) in men over 65 years of age: results from Multiple Observations in Men with ED in National Tadalafil Study in the United States

INTRODUCTION

Erectile dysfunction is increasingly common with advancing age, yet sexual activity and intimacy are important to elderly men.

AIM

To assess the efficacy and tolerability of tadalafil in men over the age of 65 years.

METHOD

In this multicenter open-label study, 188 men (mean age = 71.6 years) who were over age 65 and did not have diabetes mellitus or clinical depression received tadalafil 20 mg, taken on demand, for up to 12 weeks.

MAIN OUTCOME MEASURES

Efficacy was assessed using the International Index of Erectile Function (IIEF) and Sexual Encounter Profile (SEP). Psychosocial outcomes were evaluated using the Psychological and Interpersonal Relationship Scale (PAIRS).

RESULTS

Tadalafil treatment significantly improved all domains of the IIEF from baseline, including the erectile function (EF) domain (change = 8.8, end point = 21.6; P < 0.001). Mean per-patient percentage of "yes" responses to SEP questions concerning successful penetration (SEP2; change = 33.5%, end point = 73.5%; P < 0.001) and successful intercourse (SEP3; change = 39.6%, end point = 59.6%; P < 0.001) also improved significantly from baseline. Forty percent of the patients with baseline EF scores < 26 had normal EF (IIEF-EF domain scores > or = 26) at end point, and 81% reported improved erections in the Global Assessment Questionnaire. At least 56% of attempts at sexual intercourse were successfully completed (SEP3) at all time intervals up to 36 hours after tadalafil administration. The patients also experienced significant improvement in both the sexual self-confidence and spontaneity domains of the PAIRS. Tadalafil was well tolerated, with < 5% of the patients discontinuing because of adverse events.

CONCLUSION

Tadalafil 20 mg was effective and well tolerated in elderly men with ED.