Erectile dysfunction in primary care

Prevalence and correlates of erectile dysfunction in men on chronic haemodialysis: a multinational cross-sectional study

BACKGROUND

Factors associated with erectile dysfunction in men on haemodialysis are incompletely identified due to suboptimal existing studies. We determined the prevalence and correlates of erectile dysfunction and identified combinations of clinical characteristics associated with a higher risk of erectile dysfunction using recursive partitioning and amalgamation (REPCAM) analysis.

METHODS

We conducted a multinational cross-sectional study in men on haemodialysis within a collaborative network. Erectile dysfunction and depressive symptoms were evaluated using the erectile function domain of the International Index of Erectile Function questionnaire and the Center for Epidemiological Studies-Depression Scale, respectively.

RESULTS

Nine hundred and forty-six (59%) of 1611 eligible men provided complete data for erectile dysfunction. Eighty-three per cent reported erectile dysfunction and 47% reported severe erectile dysfunction. Four per cent of those with erectile dysfunction were receiving pharmacological treatment. Depressive symptoms were the strongest correlate of erectile dysfunction [adjusted odds ratio 2.41 (95% confidence interval (CI) 1.57-3.71)]. Erectile dysfunction was also associated with age (1.06, 1.05-1.08), being unemployed (1.80, 1.17-2.79) or receiving a pension (2.05, 1.14-3.69) and interdialytic weight gain (1.9-2.87 kg, 1.92 [CI 1.19-3.09]; >2.87 kg, 1.57 [CI 1.00-2.45]). Married men had a lower risk of erectile dysfunction (0.49, 0.31-0.76). The prevalence of erectile dysfunction was highest (94%) in unmarried and unemployed or retired men who have depressive symptoms.

CONCLUSIONS

Most men on haemodialysis experience erectile dysfunction and are untreated. Given the prevalence of this condition and the relative lack of efficacy data for pharmacological agents, we suggest that large trials of pharmacological and non-pharmacological interventions for erectile dysfunction and depression are needed.

Hope for Love: Practical Advice for Intimacy and Sex After Stroke

Stroke survivors are a major group of patients served by rehabilitation nurses. The lingering sequelae of a stroke may be devastating to a couple's relationship. This article provides practical advice that nurses can give to a stroke patient and his or her partner to cope with or overcome changes in intimacy and sexuality after a stroke. This article addresses the wide range of changes likely to occur in the patient and his or her partner, and readers are referred to additional resources for the nurse, the patient, and his or her partner. This information provides the tools for nurses to help our patients and their partners maintain their hope for love.

Improving the sexual quality of life of couples affected by erectile dysfunction: a double-blind, randomized, placebo-controlled trial of vardenafil

INTRODUCTION

Erectile dysfunction (ED) has a dual negative impact on men and their female partners; both are likely to face a drop in sexual quality of life and challenges to their intimate relationship as couples' sexual activities are curtailed by the loss of erectile function.

AIM

The primary objective of this study was to compare the efficacy of vardenafil vs. placebo in terms of success of maintenance of erection in men with ED and improvement of their female partner's sexual quality of life.

METHODS

This was a randomized, double-blind, multicenter, flexible-dose, parallel-group comparison of vardenafil vs. placebo for 12 weeks in men (> or =18 years) with ED of > or = 6 months duration, and their female partners.

MAIN OUTCOME MEASURES

Changes in patient's overall response rate to Sexual Encounter Profile question 3 (SEP3) "Did your erection last long enough for you to have sexual intercourse?" and female partner's response to the quality of life domain of the modified Sexual Life Quality Questionnaire (mSLQQ-QOL) at last observation carried forward (LOCF) were considered the primary efficacy measures. In addition, patient's response to SEP2 "Were you able to insert your penis into your partner's vagina?," the erectile function domain of the International Index of Erectile Function (IIEF-EF) and patient's mSLQQ-QOL score were also assessed.

RESULTS

Compared with placebo, vardenafil significantly improved overall least square (LS) mean per-patient SEP3 success rate (28% vs. 68%; P < 0.0001) and partner's LS mean (standard error [SE]) mSLQQ-QOL score at LOCF (32.14 [3.24] vs. 65.80 [3.10]; P < 0.0001). In addition, compared with placebo, vardenafil also improved overall LS mean per-patient SEP2 success rate (47% vs. 80%; P < 0.0001), LS mean (SE) IIEF-EF scores at LOCF (12.7 [0.8] vs. 22.8 [0.8]; P < 0.0001) and patient's LS mean (SE) mSLQQ-QOL (28.37 [3.46] vs. 63.85 [3.28]; P < 0.0001) at LOCF.

CONCLUSIONS

Vardenafil improved erectile function in men with ED and improved the sexual quality of life of the couple.

Assessment, diagnosis, and investigation of erectile dysfunction

Diagnosis of erectile dysfunction (ED) now largely rests on the medical, sexual, and psychosocial history of the patient, ideally involving the man's partner. The medical history is crucial because ED is associated with so many common disorders and their treatment. A range of validated questionnaires may be used in taking the history. They can provide an objective and systematic record. The history helps identify whether the ED is largely physical or psychogenic. In particular, gradual onset suggests a physical cause, and sudden onset suggests a psychogenic cause. Physical examinations are not usually necessary. Taking blood pressure and physical examination of the genitals for signs of Peyronie's disease and hypogonadism may be helpful. Laboratory tests that identify diabetes (glycosylated haemoglobin), hyperlipidaemia (lipids), and hypogonadism (testosterone) may identify causes of ED. A range of specialized investigations, such as ultrasound and nocturnal penile tumescence and rigidity assessment, is also available, but is not used routinely in most patients with ED.

Sexual Experience of Female Partners of Men with Erectile Dysfunction: The Female Experience of Men's Attitudes to Life Events and Sexuality (FEMALES) Study

INTRODUCTION

Much research has explored the experience of erectile dysfunction (ED) among men with ED, but far less attention has been paid to the perceptions and sexual experiences of the female partners of men with ED.

AIM

The objective of this study was to characterize the attitudes, beliefs, and sexual experience of female partners of men with erectile difficulties.

METHODS

Female partners of men with ED who had participated in the Men's Attitudes to Life Events and Sexuality (MALES) study were recruited for this research via mail or Internet, after their male partners consented to this contact. Female partners of men with ED (N = 293) responded to questionnaire measures assessing their frequency of sexual activity and the nature of their sexual experience, both before and after the development of their partner's ED, and in relation to their partner's use of phosphodiesterase type 5 (PDE5) inhibitors.

RESULTS

Women reported engaging in sexual activity significantly less frequently after their partner developed ED in comparison with before (P < 0.001). Moreover, significantly fewer women experienced sexual desire, arousal, or orgasm "almost always" or "most times," and significantly fewer women reported satisfaction with their sexual relationship after their partner developed ED, compared with before (P < 0.001). Decreases in female sexual satisfaction and frequency of orgasm were significantly related to the male partner's self-reported severity of ED (P < 0.01). The proportion of women who experienced sexual desire, arousal, and orgasm "almost always" or "most times" was significantly higher in the group whose partners were currently using a PDE5 inhibitor (P < 0.05).

CONCLUSION

Erectile dysfunction has significant adverse effects on the female partner's sexual experience. Women with partners who were currently using PDE5 inhibitors had a more satisfying sexual experience than those whose partners did not use a PDE5 inhibitor.