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Wang C, Zhang H, Wang F, Guo J, Yuan J, Hou G, Gao M, Li Z, Zhang Y. Efficacy and safety of PDE5 inhibitors in middle-aged and old patients with and without hypogonadism. Aging Male 2024; 27:2288347. [PMID: 38146937 DOI: 10.1080/13685538.2023.2288347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/19/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE Although several reviews have evaluated the use of PDE5 inhibitors (PDE5i) for treating erectile dysfunction (ED), their specific use in middle-aged and old patients has not been fully evaluated. Given that elderly patients with ED often have a complex combination of systemic and sexual health risk factors, the safety and efficacy of PDE5i in such a context are hereby reviewed. MATERIALS AND METHODS A thorough examination of existing literature has been conducted on PubMed. RESULTS PDE5i has good safety and efficacy, but the situation is more complex for patients with hypogonadism than those with normal testosterone levels, with reduced responsiveness to PDE5i. In this case, combination therapy with testosterone is recommended, safe and effective. CONCLUSIONS Eliminating or reducing reversible risk factors and controlling or slowing the development of irreversible factors is an important foundation for using PDE5i to treat ED in all patients, especially middle-aged and elderly ones.
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Affiliation(s)
- Chunlin Wang
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Hui Zhang
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming Gao
- Department of Andrology, Xi'an Daxing Hospital affiliated to Yan'an University, Xi'an, China
| | - Zheng Li
- Shanghai Key Laboratory of Reproductive Medicine, Department of Andrology, Center for Men's Health, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhang
- Department of Infertility and Sexual Medicine, 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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2
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Lo JO, Hedges JC, Chou WH, Tager KR, Bachli ID, Hagen OL, Murphy SK, Hanna CB, Easley CA. Influence of substance use on male reproductive health and offspring outcomes. Nat Rev Urol 2024; 21:534-564. [PMID: 38664544 DOI: 10.1038/s41585-024-00868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/30/2024]
Abstract
The prevalence of substance use globally is rising and is highest among men of reproductive age. In Africa, and South and Central America, cannabis use disorder is most prevalent and in Eastern and South-Eastern Europe, Central America, Canada and the USA, opioid use disorder predominates. Substance use might be contributing to the ongoing global decline in male fertility, and emerging evidence has linked paternal substance use with short-term and long-term adverse effects on offspring development and outcomes. This trend is concerning given that substance use is increasing, including during the COVID-19 pandemic. Preclinical studies have shown that male preconception substance use can influence offspring brain development and neurobehaviour through epigenetic mechanisms. Additionally, human studies investigating paternal health behaviours during the prenatal period suggest that paternal tobacco, opioid, cannabis and alcohol use is associated with reduced offspring mental health, in particular hyperactivity and attention-deficit hyperactivity disorder. The potential effects of paternal substance use are areas in which to focus public health efforts and health-care provider counselling of couples or individuals interested in conceiving.
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Affiliation(s)
- Jamie O Lo
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA.
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA.
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
| | - Jason C Hedges
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Wesley H Chou
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA
| | - Kylie R Tager
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
| | - Ian D Bachli
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
| | - Olivia L Hagen
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Carol B Hanna
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Charles A Easley
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
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Walicka M, Krysiński A, La Rosa GRM, Sun A, Campagna D, Di Ciaula A, Dugal T, Kengne A, Le Dinh P, Misra A, Polosa R, Raza SA, Russo C, Sammut R, Somasundaram N. Influence of quitting smoking on diabetes-related complications: A scoping review with a systematic search strategy. Diabetes Metab Syndr 2024; 18:103044. [PMID: 38810420 DOI: 10.1016/j.dsx.2024.103044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Smoking in people with diabetes markedly elevates their risk of developing complications and increases the likelihood of cardiovascular mortality. This review is the first to specifically provide evidence-based analysis about the influence of quitting smoking on diabetes-related complications in people with type 2 diabetes. METHOD The present review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All human clinical studies assessing the effects of stopping smoking cessation on diabetes-related complications were included. PubMed and Embase were screened until January 2024. References of primary studies and principal peer-reviewed scientific journals in the field were manually screened. RESULTS We identified a total of 1023 studies. Only 26 met the criteria for eligibility. In general quitting smoking is associated with decreased risks of myocardial infarction and ischemic stroke. Regarding microvascular complications, the strongest evidence for the beneficial effects of smoking cessation is observed in diabetic nephropathy. However, the relationship between smoking cessation and retinopathy, neuropathy, diabetic foot complications and diabetic-related erectile dysfunction, is poorly investigated. CONCLUSION Quitting smoking offers significant advantages in managing diabetes-related complications, significantly lowering the risks of myocardial infarction, ischemic stroke, and diabetic nephropathy. This underscores the importance of cessation. Providing evidence-based information on the benefits of stopping smoking for people with type 2 diabetes who smoke, can bolster smoking cessation efforts in the context of diabetes management.
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Affiliation(s)
- Magdalena Walicka
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland; Department of Internal Diseases, Endocrinology and Diabetology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland.
| | - Arkadiusz Krysiński
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland; Department of Internal Diseases, Endocrinology and Diabetology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
| | | | - Ang Sun
- Department of Biology, and Center for Biotechnology/Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, USA
| | - Davide Campagna
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Agostino Di Ciaula
- Clinica Medica "A. Murri" Department of Precision and Regenerative Medicine and Ionian Area [DiMePre-J], University "Aldo Moro" Medical School, Bari, Italy
| | - Tabinda Dugal
- Department of Endocrinology College of Physicians and Surgeons, Royal Cornwall Hospital NHS Trust, Truro, UK
| | - Andre Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council and University of Cape Town, Cape Town, South Africa; Department of Biological and Environmental Science, Faculty of Science, Walter Sisulu University, Mthatha, South Africa
| | - Phuong Le Dinh
- General Practice, Family Medicine and Check-up Department, FV Hospital Ho Chi Minh City, Viet Nam
| | - Anoop Misra
- Diabetes Foundation [India], New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation [N-DOC], New Delhi, India; Fortis C-DOC Centre for Excellence for Diabetes, Metabolic Disease, and Endocrinology, New Delhi, India
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Center of Excellence for the acceleration of Harm Reduction [CoEHAR], University of Catania, Vietnam, Italy; Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Syed Abbas Raza
- Shaukat Khanum Cancer Hospital and Research Center, Peshawar, Pakistan
| | - Cristina Russo
- Ashford and Saint Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Roberta Sammut
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
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4
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Duarte Romero B, Waterhouse M, Baxter C, McLeod DSA, English DR, Armstrong BK, Chung E, Ebeling PR, Hartel G, van der Pols JC, Roberts M, Venn AJ, Webb PM, Whiteman DC, Neale RE. The effect of three years of vitamin D supplementation on erectile dysfunction: Results from the randomized placebo-controlled D-Health Trial. Clin Nutr ESPEN 2024; 60:109-115. [PMID: 38479897 DOI: 10.1016/j.clnesp.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Erectile dysfunction is common among older men and has been associated with low serum 25-hydroxy vitamin D concentration. However, this association may be due to uncontrolled confounding, and there is a paucity of evidence from interventional studies. We aimed to examine the effect of vitamin D supplementation on the prevalence of erectile dysfunction, in an exploratory analysis using data from a large randomized controlled trial. METHODS The D-Health Trial recruited Australians aged 60-84 years between January 2014 and May 2015 and randomly assigned them to supplementation with 60,000 IU of vitamin D or placebo per month for up to 5 years. Blood samples were collected annually from randomly selected participants (total N = 3943). We assessed erectile dysfunction at the end of the third year of follow-up. We used log-binomial regression to examine the effect of vitamin D on the prevalence of erectile dysfunction overall, and within sub-groups. RESULTS Of the 11,530 men enrolled, 8920 (77.4 %) completed the erectile dysfunction question and were included in the analysis. After three years of supplementation, the mean serum 25-hydroxy vitamin D concentration was 76 nmol/L (standard deviation (SD) 24.94) in the placebo group and 106 nmol/L (SD 26.76) in the vitamin D group (p < 0.0001). The prevalence of erectile dysfunction was 58.8 % and 59.0 % in the vitamin D and placebo groups, respectively (prevalence ratio 1.00, 95 % CI 0.97, 1.03); there was no evidence of an effect of vitamin D in any subgroup analyses. CONCLUSION Supplementing older men with vitamin D is unlikely to prevent or improve erectile dysfunction. CLINICAL TRIALS REGISTRY (ACTRN12613000743763).
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Affiliation(s)
- Briony Duarte Romero
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Mary Waterhouse
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Catherine Baxter
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Donald S A McLeod
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Dallas R English
- Melbourne School of Population Health, University of Melbourne, Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | | | - Eric Chung
- University of Queensland, Department of Urology, Princess Alexadra Hospital, Brisbane, Australia; AndroUrology Centre, Brisbane, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Gunter Hartel
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jolieke C van der Pols
- Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Brisbane, Australia
| | - Matthew Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia.
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Stenlund S, Sillanmäki L, Koivumaa-Honkanen H, Rautava P, Lagström H, Suominen S. A healthy lifestyle can support future sexual satisfaction: results from a 9-year longitudinal survey. J Sex Med 2024; 21:304-310. [PMID: 38441479 DOI: 10.1093/jsxmed/qdae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Previous follow-up studies have demonstrated the association between good health behavior and good sexual functioning for men, but the longitudinal relationship between multiple health behaviors and satisfaction with sex life remains understudied. AIM The aim of the study was to explore whether good health behavior associates with improved satisfaction with sex life for men and women in a follow-up of 9 years. METHODS This cohort study utilized survey data from the population-based Health and Social Support study. It includes responses from 10 671 working-aged Finns. Using linear regression models, we examined a composite sum score representing 4 health behaviors (range, 0-4) in 2003 as a predictor of satisfaction with sex life in 2012. The analyses adjusted for various covariates in 2003, including satisfaction with sex life, living status, age, gender, education, number of diseases, and importance of sex life in 2012. OUTCOMES The outcome in the study was satisfaction with sex life in the year 2012. RESULTS Participants who exhibited better health behavior at baseline demonstrated improved satisfaction with sex life when compared with those with poorer health behavior (β = -0.046, P = .009), even when controlling for the aforementioned covariates. The positive effect of reporting all beneficial health behaviors vs none of them was greater than having none vs 3 chronic conditions. Furthermore, this was almost half the effect of how satisfaction with sex life in 2003 predicted its level in 2012. These findings were supported by an analysis of the congruence of health behavior in the observation period from 2003 to 2012 predicting changes in satisfaction with sex life. CLINICAL IMPLICATIONS The results could serve as a motivator for a healthy lifestyle. STRENGTHS AND LIMITATIONS The current study used a longitudinal large sample and a consistent survey procedure, and it explored the personal experience of satisfaction instead of sexual function. However, the study is limited in representing today's diversity of gender, since the options for gender at the time of survey were only male and female. CONCLUSION These findings indicate that engaging in healthy behaviors contributes to the maintenance and enhancement of satisfaction with sex life over time.
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Affiliation(s)
- Säde Stenlund
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada
- Department of Psychology, University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
- Department of Public Health, University of Helsinki, Helsinki, 00014, Finland
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, University of Eastern Finland, Kuopio, 70029, Finland
- Kuopio University Hospital, Kuopio, 70029, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, 20014, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, 20014, Finland
- Research Services, Turku University Hospital, Turku, 20014, Finland
- School of Health Sciences, University of Skövde, Skövde, 54128, Sweden
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Kalka C, Keo HH, Ingwersen M, Knoechel J, Hoppe H, Do DD, Schumacher M, Diehm N. Men with erectile dysfunction (ED) should be screened for cardiovascular risk factors - Cost-benefit considerations in Swiss men. VASA 2024; 53:68-76. [PMID: 38047756 DOI: 10.1024/0301-1526/a001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background: Current evidence indicates that erectile dysfunction (ED) is an independent risk factor for future cardiovascular events. This study aimed to estimate the cost-effectiveness of screening and subsequent preventive treatment for cardiovascular risk factors among men newly diagnosed with ED from the Swiss healthcare system perspective. Methods: Based on known data on ED and cardiovascular disease (CVD) prevalence and incidence costs and effects of a screening intervention for cardiovascular risk including corresponding cardiovascular prevention in men with ED were calculated for the Swiss population over a period of 10 years. Results: Screening and cardiovascular prevention over a period of 10 years in Swiss men with ED of all seriousness degrees, moderate and severe ED only, or severe ED only can probably avoid 41,564, 35,627, or 21,206 acute CVD events, respectively. Number needed to screen (NNS) to prevent one acute CVD event is 30, 23, and 10, respectively. Costs for the screening intervention are expected to be covered at the seventh, the fifth, and the first year, respectively. Conclusion: Screening and intervention for cardiovascular risk factors in men suffering from ED is a cost-effective tool not only to strengthen prevention and early detection of cardiovascular diseases but also to avoid future cardiovascular events.
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Affiliation(s)
- Christoph Kalka
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Cologne, Germany
| | - Hak-Hong Keo
- Vascular Institute Central Switzerland, Aarau, Switzerland
- Department of Angiology, University Hospital of Basel, Switzerland
| | - Maja Ingwersen
- Department of Radiology, Friedrich-Schiller-University, Jena University Hospital, Jena, Germany
| | - Jonas Knoechel
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Hanno Hoppe
- University of Lucerne, Switzerland
- University of Bern, Switzerland
| | - Dai-Do Do
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Bern, Switzerland
| | | | - Nicolas Diehm
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Bern, Switzerland
- University of Applied Sciences Furtwangen, Villingen-Schwenningen, Germany
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7
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Habous M, Khattak A, Farag M, Binsaleh S, Ralph D, Aziz M, Bettocchi C, Muir G. Investigating the risk factors of penile arterial insufficiency and veno-occlusive dysfunction in patients with erectile dysfunction. BJUI COMPASS 2024; 5:34-41. [PMID: 38179020 PMCID: PMC10764169 DOI: 10.1002/bco2.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/20/2023] [Accepted: 07/10/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To investigate the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED). Methods Patients who attended our urology clinic complaining of ED for more than 6 months were prospectively enrolled in this study over 1-year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie's disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile and glycated haemoglobin (HA1c). A penile duplex ultrasound study (PDU) was done for all patients after intracavernosal injection (ICI) with alprostadil. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured after 15 min. Statistical analysis was done using SPSS. Results A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r = -0.361, P = 0.000) and higher EDV (r = 0.174, P = 0.001), and both correlations were highly statistically significant. Diabetics had lower PSV (r = -0.318, P = 0.000) and higher EDV (r = 0.139, P = 0.008), which were also highly statistically significant. Smokers had lower PSV (r = -0.140, P = 0.008) and higher EDV (r = 0.178, P = 0.001), which were highly statistically significant. Men with larger penises measured skin to tip had lower EDV (r = -0.119, P = 0.024), which was less significant. Interestingly, there was neither a significant correlation between BMI and PSV (0.16, P = 0.745) nor a significant correlation between testosterone and PSV (0.029, P = 0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD. Conclusions Ageing, tobacco consumption, DM and hypertension seem to have a negative impact on penile haemodynamics, which was statistically significant. In our patients, there was no statistically significant effect on penile haemodynamics in patients with increased BMI, low testosterone or PD or according to the size of the penis.
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Affiliation(s)
| | | | - Mohammed Farag
- Urology DepartmentAzhar University, Assiut BranchAssiutEgypt
| | - Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - David Ralph
- St. Peters Institute of Andrology, UCLHLondonUK
| | - Mohammed Aziz
- Urology DepartmentMenofia UniversityShibin Al KawmEgypt
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8
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Allen MS, Tostes RC. Cigarette smoking and erectile dysfunction: an updated review with a focus on pathophysiology, e-cigarettes, and smoking cessation. Sex Med Rev 2023. [DOI: 10.1093/sxmrev/qeac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abstract
Introduction
Cigarette smoking has major health implications and causes substantial damage to all organ systems. Approximately one-third of men are active smokers worldwide, and most men are unaware that cigarette smoking can contribute to erectile dysfunction (ED).
Objectives
This article aims to provide a comprehensive overview of research conducted on cigarette smoking and ED, with a particular focus on pathophysiology, electronic cigarettes (e-cigarettes), and smoking cessation.
Methods
A manual literature search was conducted on all research conducted on cigarette smoking and ED up to October 2022.
Results
Substantial evidence is now available showing that past and current cigarette smoking has dose-dependent associations with ED in studies controlling for age and important health comorbidities. Cigarette smoke contains nicotine, carbon monoxide, oxidant chemicals, and metals that can damage the endothelium and disrupt erectile processes. For current smokers, smoking abstinence can strengthen the endothelium and reverse diminished erectile function. The effect of e-cigarettes on endothelial damage and ED remains largely untested. E-cigarettes expose users to fine and ultrafine particles and toxins that can increase risk of cardiovascular injury, but these acute effects appear less potent than conventional cigarettes (long-term cardiovascular effects are still unknown). E-cigarettes are therefore likely to have less harmful effects on ED than conventional cigarettes.
Conclusions
Smoking cessation programs that focus on nicotine replacement therapy (transdermal patches, gum, or inhalers), behavioral counseling, social support, and education programs can be effective approaches to ED treatment in active smokers. Temporarily transferring from regular cigarettes to e-cigarettes—which transmit some of the same carcinogens as conventional cigarettes and are likely to have some long-term cardiovascular effects that disrupt erectile function—might also be useful for long-term smoking cessation and treatment of ED.
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Affiliation(s)
- Mark S Allen
- Department of Psychology and Therapeutic Studies , Leeds Trinity University, Leeds, LS18 5HD, UK
| | - Rita C Tostes
- Department of Pharmacology, University of São Paulo , São Paulo, Brazil
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9
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Yang H, Breyer BN, Rimm EB, Giovannucci E, Loeb S, Kenfield SA, Bauer SR. Plant-based diet index and erectile dysfunction in the Health Professionals Follow-Up Study. BJU Int 2022; 130:514-521. [PMID: 35484829 PMCID: PMC9474604 DOI: 10.1111/bju.15765] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the longitudinal association between plant-based diet index (PDI) score and incident erectile dysfunction (ED). MATERIALS AND METHODS We conducted a prospective analysis of 21 942 men aged 40 to 75 years who were enrolled in the Health Professionals Follow-Up Study. ED was assessed with questionnaires every 4 years starting in 2000. Dietary data were collected via validated food frequency questionnaires completed every 4 years and were used to calculate total PDI scores, as well as healthy (hPDI) and unhealthy (uPDI) subscores. Multivariable Cox proportional hazards models were used to compute hazard ratios (HRs) for incident ED. All models were stratified by age (<60, 60 to <70, ≥70 years). RESULTS Among men aged 60 to <70 years, hPDI was inversely associated with incident ED. Those in the highest quintile of hPDI in that age group had an 18% lower risk of ED (HR 0.82, 95% confidence interval (CI) 0.73-0.91; P-trend <0.001) compared to those in the lowest quintile. Conversely, uPDI was positively associated with ED in men aged <60 years (HR 1.27, 95% CI 1.01-1.60; P-trend = 0.02). CONCLUSIONS Encouraging a healthy plant-based diet may be an environmentally sustainable intervention for men interested in maintaining erectile function.
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Affiliation(s)
| | | | - Eric B. Rimm
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Edward Giovannucci
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs
| | - Stacey A. Kenfield
- Department of Urology, UCSF
- Department of Epidemiology & Biostatistics, UCSF
| | - Scott R. Bauer
- Department of Urology, UCSF
- Division of General Internal Medicine, Department of Medicine, UCSF
- San Francisco Veterans Affairs Healthcare System
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10
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Mima M, Huang JB, Andriole GL, Freedland SJ, Ohlander SJ, Moreira DM. The Impact of Smoking on Sexual Function. BJU Int 2022; 130:186-192. [PMID: 35166438 DOI: 10.1111/bju.15711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Smoking is a well-established risk factor for sexual dysfunction. However, the impact of smoking cessation on sexual function is unclear. We hypothesize that there is an improvement in sexual function following smoking cessation. To evaluate this hypothesis, we analyzed the association between cigarette smoking and smoking cessation with sexual function among participants of the Reduction by Dutasteride in Prostate Cancer Events (REDUCE) study. MATERIALS AND METHODS We analyzed baseline data of 6,754 men, ages 50-75 years-old divided into: lifelong nonsmokers, former smokers and current smokers. We examined total testosterone (TT, normal range ≥10 nmol/L) and sexual function variables: self-reported sexual activity, low libido and erectile dysfunction. Differences between current vs nonsmokers and former vs current smokers were analyzed using chi-square test, linear and logistic regressions. RESULTS A total of 3,069 (45.4%) men were nonsmokers, 2,673 (39.6%) former smokers, and 1,012 (15%) current smokers. Current smokers were significantly younger than former and nonsmokers (mean age 61.6, 63.2, 62.7 years), leaner (mean body-mass index 27.0, 27.7, 27.2 kg/m2 ), and had less hypertension (32.4%, 41.6%, 36.8%, respectively, all P < 0.01). In uni- and multivariable analysis, current smokers had higher mean TT compared to nonsmokers (485.4, 451.2 nmol/L, P < 0.001), higher prevalence of low libido (25.6%, 21.0%, P=0.002) and erectile dysfunction (31.6%, 26.0%, respectively, P < 0.001) with comparable sexual activity (81.7%, 82.8%, respectively, P=0.420). In multivariable analysis, former smoker had statistically significant less prevalence of low libido (OR: 0.8, P=0.013) and erectile dysfunction (OR: 0.8, P=0.006) compared to current smokers. CONCLUSION Cigarette smoking was associated with worse sexual health compared to nonsmoker, while former smokers had better erectile function and libido than current smokers. Smoking cessation may improve male sexual health and counselling on smoking cessation may be considered at the time of sexual health evaluations.
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Affiliation(s)
- Mahmoud Mima
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jason B Huang
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel J Ohlander
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Daniel M Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Ju R, Ruan X, Xu X, Yang Y, Cheng J, Zhang L, Wang B, Qin S, Dou Z, Mueck AO. Importance of active and passive smoking as one of the risk factors for female sexual dysfunction in Chinese women. Gynecol Endocrinol 2021; 37:541-545. [PMID: 34027789 DOI: 10.1080/09513590.2021.1913115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess possible risk factors for female sexual dysfunction (FSD), aiming especially at smoking in China. METHODS Female Sexual Function Index (FSFI) for assessing FSD; 621 women (24-75 years) divided into 'group FSD' (FSFI≤ 26.55) and 'group No FSD' (FSFI > 26.55). Univariate and multivariate analysis to detect potential risk factors for FSD. RESULTS Active smoking was the strongest risk factor after multiple adjustments (OR= 6.226, 95%CI = 1.561 ∼ 24.822), but passive smoking also was significantly associated with a risk of FSD (OR = 1.887, 95%CI = 1.092 ∼ 3.260) (p < .05). Other risk factors included age (OR = 1.040, 95%CI = 1.005 ∼ 1.076), medical comorbidities (OR= 1.688, 95%CI =1.044 ∼ 2.729), postmenopausal stage (OR= 2.021, 95%CI = 1.073 ∼ 5.717), and dissatisfied marital relations (OR= 3.771, 95%CI = 1.768 ∼ 8.045). The prevalence of FSD for smokers regarding disorders of sexual arousal, orgasm and sexual satisfaction increased in active smokers; sexual desire disorder, sexual arousal disorder and pain in secondhand smokers (p < .05). CONCLUSION The risk of FSD was closely related to depletion of ovarian function. Active smokers had the highest risk, but passive smoking also had a significant relationship to FSD. Although female smokers are rare in China, 'husband smoking' is frequent. Thus, our results should have significant healthcare consequences.
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Affiliation(s)
- Rui Ju
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xiangyan Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Women's Health, University Women's Hospital and Research Centre for Women's Health, University of Tuebingen, Tuebingen, Germany
| | - Xin Xu
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yu Yang
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jiaojiao Cheng
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Luping Zhang
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Binhong Wang
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Shuang Qin
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zhuli Dou
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Alfred O Mueck
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Women's Health, University Women's Hospital and Research Centre for Women's Health, University of Tuebingen, Tuebingen, Germany
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Abstract
: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.
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Sansone A, Limoncin E, Colonnello E, Mollaioli D, Ciocca G, Corona G, Jannini EA. Harm Reduction in Sexual Medicine. Sex Med Rev 2021; 10:3-22. [DOI: 10.1016/j.sxmr.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
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Sahin MO, Sen V, Gunduz G, Ucer O. Effect of smoking cessation on sexual functions in men aged 30 to 60 years. Int Braz J Urol 2020; 46:642-648. [PMID: 32374127 PMCID: PMC7239286 DOI: 10.1590/s1677-5538.ibju.2019.0541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/08/2019] [Indexed: 12/04/2022] Open
Abstract
Purpose We aimed to evaluate the effects of smoking cessation on the sexual functions in men aged 30 to 60 years. Materials and Methods Male patients aged 30 to 60 years that presented to the smoking cessation polyclinic between July 2017 and December 2018 were prospectively included in the study. The amount of exposure to tobacco was evaluated in pack-year. The patients filled the International Index of Erectile Function (IIEF) form before the cessation and six months after cessation of smoking. Patients were subgrouped according to age, education level and packs/year of smoking and this groups were compared in terms of IIEF total and all of the IIEF domains. Results The evaluations performed by grouping the patients according to age (30-39, 40-49 and 50-60 years) and education level (primary-middle school and high school-university) revealed that the total IIEF scores obtained after smoking cessation were significantly higher compared to the baseline scores in all groups (p=0.007 for the 30-39 years group and p <0.001 for the remaining groups). According to grouping by exposure to smoking (≤25, 26-50, 51-75, 76-100 and 101≥ packs/year), the total IIEF scores significantly increased after smoking cessation in all groups except 101≥ packs/year (p=0.051 for the 101≥ group and p <0.001 for the remaining groups). Conclusions Erectile function is directly proportional to the degree of exposure to smoking, and quitting smoking improves male sexual function in all age groups between 30-60 years of age regardless of pack-year and education level.
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Affiliation(s)
| | - Volkan Sen
- Department of Urology, Manisa State Hospital, Manisa, Turkey
| | - Gazi Gunduz
- Department of Chest Diseases, Manisa State Hospital, Manisa, Turkey
| | - Oktay Ucer
- Department of Urology, Manisa Celal Bayar University School of Medicine, Manisa, Turkey
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Bauer SR, Breyer BN, Stampfer MJ, Rimm EB, Giovannucci EL, Kenfield SA. Association of Diet With Erectile Dysfunction Among Men in the Health Professionals Follow-up Study. JAMA Netw Open 2020; 3:e2021701. [PMID: 33185675 PMCID: PMC7666422 DOI: 10.1001/jamanetworkopen.2020.21701] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Erectile dysfunction, especially in younger men, is an early sign of cardiovascular disease and may decrease quality of life. Men may be motivated to adopt a healthy dietary pattern if it lowers their risk of erectile dysfunction. OBJECTIVE To assess the association between adherence to a diet quality index based on healthy dietary patterns and erectile dysfunction in men. DESIGN, SETTING, AND PARTICIPANTS This population-based prospective cohort study included men from the Health Professionals Follow-up Study with follow-up from January 1, 1998, through January 1, 2014. Participants included US male health professionals aged 40 to 75 years at enrollment. Men with erectile dysfunction or a diagnosis of myocardial infarction, diabetes, stroke, or genitourinary cancer at baseline were excluded. Analyses were completed in February 2020. EXPOSURES A food frequency questionnaire was used to determine nutrient and food intake every 4 years. MAIN OUTCOMES AND MEASURES Diet quality was assessed by Mediterranean Diet score and the Alternative Healthy Eating Index 2010 score, with higher scores indicating healthier diet. Dietary index scores were cumulatively updated from 1986 until men developed erectile dysfunction, cardiovascular disease, died, or were lost to follow-up. Incident erectile dysfunction was assessed with questionnaires in 2000, 2004, 2008, and 2012. Hazard ratios (HRs) by prespecified categories or quintiles of dietary index scores were estimated using Cox proportional hazards regression analyses stratified by age. RESULTS Among 21 469 men included in analysis, mean (SD) age at baseline was 62 (8.4) years. During a mean (SD) follow-up of 10.8 (5.4) years and 232 522 person-years, there were 968 incident erectile dysfunction cases among men younger than 60 years, 3703 cases among men aged 60 to less than 70 years, and 4793 cases among men aged 70 years or older. Men younger than 60 years and in the highest category of the Mediterranean Diet score had the lowest relative risk of incident erectile dysfunction compared with men in the lowest category (HR, 0.78; 95% CI, 0.66-0.92). Higher Mediterranean diet scores were also inversely associated with incident erectile dysfunction among older men (age 60 to <70 years: HR, 0.82; 95% CI, 0.76-0.89; age ≥70 years: HR, 0.93; 95% CI, 0.86-1.00). Men scoring in the highest quintile of the Alternative Healthy Eating Index 2010 also had a lower risk of incident erectile dysfunction, particularly among men age younger than 60 years (quintile 5 vs quintile 1: HR, 0.78; 95% CI, 0.63-0.97). CONCLUSIONS AND RELEVANCE This cohort study found that adherence to healthy dietary patterns was associated with a lower risk for erectile dysfunction, suggesting that a healthy dietary pattern may play a role in maintaining erectile health.
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Affiliation(s)
- Scott R. Bauer
- Department of Medicine, University of California, San Francisco
- Department of Urology, University of California, San Francisco
- Division of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Benjamin N. Breyer
- Department of Urology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Meir J. Stampfer
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Eric B. Rimm
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Edward L. Giovannucci
- Departments of Nutrition & Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stacey A. Kenfield
- Department of Urology, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Corona G, Sansone A, Pallotti F, Ferlin A, Pivonello R, Isidori AM, Maggi M, Jannini EA. People smoke for nicotine, but lose sexual and reproductive health for tar: a narrative review on the effect of cigarette smoking on male sexuality and reproduction. J Endocrinol Invest 2020; 43:1391-1408. [PMID: 32323225 DOI: 10.1007/s40618-020-01257-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To systematically review the impact of smoking habits on cardiovascular (CV) as well as on male sexual and reproductive function and to provide updated evidence on the role of electronic cigarettes (e-Cig) on the same topics. METHODS A comprehensive Medline, Embase, and Cochrane search was performed including the following words: smoking, CV system, CV risk, erectile dysfunction (ED), and male fertility. Publications from January 1, 1969 up to February 29, 2020 were included. RESULTS Smoking has a tremendous negative impact on CV mortality and morbidity. Current smoking behavior is also negatively associated with erectile dysfunction (ED) and impaired sperm parameters. E-Cig can release significantly lower concentrations of harmful substances when compared to regular combustible cigarettes. Whether or not the latter can result in positive CV, sexual, and fertility outcomes is still under study. Preliminary studies showed that exposure to e-Cig leads to lower vascular damage when compared to the traditional cigarette use. However, data on the long-term effects of e-Cig are lacking. Similarly, preliminary data, obtained in animal models, have suggested a milder effect of e-Cig on erectile function and sperm parameters. CONCLUSION Available evidence showed that e-Cig are much less dangerous when compared to the traditional tobacco use. However, it should be recognized that the risk related to e-Cig is still higher when compared to that observed in non-smoking patients. Hence, e-Cig should be considered as a potential tool, in the logic of harm reduction, to reduce the CV, sexual and fertility risk in patients refractory to the fundamental, healthy choice to definitively quit smoking.
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Affiliation(s)
- G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy
| | - A Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Ferlin
- Unit of Endocrinology and Metabolism, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - R Pivonello
- Division of Endocrinology, Università Degli Studi Di Napoli "Federico II", Naples, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | - E A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy.
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17
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Huynh LM, Liang K, Osman MM, El-Khatib FM, Dianatnejad S, Towe M, Roberts NH, Yafi FA. Organic Diet and Intermittent Fasting are Associated With Improved Erectile Function. Urology 2020; 144:147-151. [PMID: 32717247 DOI: 10.1016/j.urology.2020.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 07/09/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To explore associations between dietary habits and erectile dysfunction (ED) in a cohort of patients presenting to a high-volume men's health clinic. MATERIALS AND METHODS All patients presenting to a high-volume men's health clinic between July 2018 and May 2019 were evaluated for their dietary habits and screened with the International Index of Erectile Function-5 (IIEF-5) and Androgen Deficiency in Aging Males (ADAM). The primary outcome measure was the impact of dietary habits on ED, defined as IIEF-5 <22. Stepwise logistic regressions were used to control for patient characteristics and relevant comorbidities. RESULTS Two hundred seventy-one patients were included. Primary reasons for visit were ED (110, 40.6%), hypogonadism (39, 14.4%), benign prostatic hyperplasia/lower urinary tract symptoms (80, 29.5%), and Peyronie's Disease (30, 11.1%). 176 (64.9%) followed no diet, while 11 (4.1%), 11 (4.1%), 8 (2.9%), and 11 (4.1%) were whole food only, low-carb/keto, vegetarian/pescatarian, and low-fat, respectively. Additionally, 105 (38.7%) reported organic foods consumption, while 51 (18.8%) had no processed food consumption, and 77 (28.4%) performed intermittent fasting. Patients reporting ED were more likely to be over the age of 65, had higher body mass index, more comorbidities, and less likely to report an organic diet or intermittent fasting. There were no correlations between diet and ADAM score. In adjusted analysis, patients reporting organic diet or intermittent fasting were significantly less likely to have ED. CONCLUSION This is the first study suggesting organic diet and intermittent fasting to be protective against ED. These results are hypothesis-generating and warrant further exploration.
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Affiliation(s)
- Linda M Huynh
- Department of Urology, University of California, Irvine Health, Orange, CA
| | - Karren Liang
- Department of Urology, University of California, Irvine Health, Orange, CA
| | - Mohamad M Osman
- Department of Urology, University of California, Irvine Health, Orange, CA
| | - Farouk M El-Khatib
- Department of Urology, University of California, Irvine Health, Orange, CA
| | | | - Maxwell Towe
- Department of Urology, University of California, Irvine Health, Orange, CA
| | | | - Faysal A Yafi
- Department of Urology, University of California, Irvine Health, Orange, CA.
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Lin JH, Ho DR, Shi CS, Chen CS, Li JM, Huang YC. The influence of smoking exposure and cessation on penile hemodynamics and corporal tissue in a rat model. Transl Androl Urol 2020; 9:637-645. [PMID: 32420170 PMCID: PMC7215033 DOI: 10.21037/tau.2019.12.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background While epidemiological studies have clearly documented that smoking cessation significantly enhances sexual health, the underlying mechanism remains largely unknown. Thus, we wished to explore possible mechanisms by using a rat model of smoking-associated erectile dysfunction (ED). Methods Forty 8-week old male Sprague-Dawley rats were divided into 4 groups. Ten rats were exposed only to room air (N group). The remaining 30 rats were passively exposed to cigarette smoke over a 12-week period. At the end of 12 weeks, the smoking (S, n=10) group underwent immediate erectile function testing and were sacrificed. The remaining 20 rats were exposed to room air only for 4 (Q4W, n=10) or 8 (Q8W, n=10) weeks and then underwent erectile function testing and sacrifice. Erectile function was evaluated by measuring intracavernous pressure (ICP) and mean arterial pressure (MAP). After blood collection for serum testosterone determination, rats were sacrificed to obtain corporal tissue for immunohistochemistry. Results Mean ICP/MAP ratio was significantly lower in the S group compared to the N and Q8W groups (0.52±0.11, 0.94±0.05, and 0.94±0.12, respectively, P=0.0189). Smooth muscle/collagen ratio was also significantly lower in the S group compared to the N and Q8W groups (11.8±0.94, 17.5±1.82, and 16.4±0.60, respectively, P=0.0008). Oxidative stress and apoptotic indices were significantly higher in the S group compared to the N and Q8W groups. Neuronal and endothelial nitric oxide synthases were significantly less expressed in the S group compared to the N and Q8W groups. Conclusions Smoking cessation is associated with partial recovery of penile hemodynamics in a rat model of smoking associated ED.
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Affiliation(s)
- Jian-Hui Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Dong-Ru Ho
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Chung-Sheng Shi
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan
| | - Chih-Shou Chen
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Jhy-Ming Li
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan.,Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Yun-Ching Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan
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Mollaioli D, Ciocca G, Limoncin E, Di Sante S, Gravina GL, Carosa E, Lenzi A, Jannini EAF. Lifestyles and sexuality in men and women: the gender perspective in sexual medicine. Reprod Biol Endocrinol 2020; 18:10. [PMID: 32066450 PMCID: PMC7025405 DOI: 10.1186/s12958-019-0557-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/17/2018] [Indexed: 01/13/2023] Open
Abstract
Sexual health is strictly related with general health in both genders. In presence of a sexual dysfunction, the expert in sexual medicine aims to discover the specific weight of the physical and psychological factors can cause or con-cause the sexual problem. At the same time, a sexual dysfunction can represent a marker of the future development of a Non-communicable diseases (NCDss) as cardiovascular or metabolic diseases.In the evaluation phase, the sexual health specialist must focus on these aspects, focusing especially on the risk and protective factors that could impact on both male and female sexuality.This article presents a review of researches concerning healthy and unhealthy lifestyles and their contribute in the development of sexual quality of life in a gender-dependent manner.Among the unhealthy lifestyle, obesity contributes mostly to the development of sexual dysfunctions, due to its negative impact on cardiovascular and metabolic function. Tobacco smoking, alcohol - substance abuse and chronic stress lead to the development of sexual dysfunction in a med-long term.In order to guarantee a satisfying sexual quality of life, sexual health specialists have the responsibility to guide the patient through the adoption of healthy lifestyles, such as avoiding drugs, smoke and excessive alcohol, practicing a regular physical activity, following a balanced diet and use stress-management strategies, even before proposing both pharmaco- and/or psychotherapies.
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Affiliation(s)
- Daniele Mollaioli
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giacomo Ciocca
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Erika Limoncin
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Stefania Di Sante
- grid.7841.aDepartment of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, Rome, 00161 Italy
| | - Giovanni Luca Gravina
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio (Coppito 2), L’Aquila, 67100 Italy
| | - Eleonora Carosa
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio (Coppito 2), L’Aquila, 67100 Italy
| | - Andrea Lenzi
- grid.7841.aDepartment of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, Rome, 00161 Italy
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Pharmacology and perspectives in erectile dysfunction in man. Pharmacol Ther 2020; 208:107493. [PMID: 31991196 DOI: 10.1016/j.pharmthera.2020.107493] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/05/2019] [Indexed: 12/15/2022]
Abstract
Penile erection is a perfect example of microcirculation modulated by psychological factors and hormonal status. It is the result of a complex neurovascular process that involves the integrative synchronized action of vascular endothelium; smooth muscle; and psychological, neuronal, and hormonal systems. Therefore, the fine coordination of these events is essential to maintain penile flaccidity or allow erection; an alteration of these events leads to erectile dysfunction (ED). ED is defined as the consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual activity. A great boost to this research field was given by commercialization of phosphodiesterase-5 (PDE5) inhibitors. Indeed, following the discovery of sildenafil, research on the mechanisms underlying penile erection has had an enormous boost, and many preclinical and clinical papers have been published in the last 10 years. This review is structured to provide an overview of the mediators and peripheral mechanism(s) involved in penile function in men, the drugs used in therapy, and the future prospective in the management of ED. Indeed, 30% of patients affected by ED are classified as "nonresponders," and there is still an unmet need for therapeutic alternatives. A flowchart suggesting the guidelines for ED evaluation and the ED pharmacological treatment is also provided.
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Male Sexual and Reproductive Health-Does the Urologist Have a Role in Addressing Gender Inequality in Life Expectancy? Eur Urol Focus 2019; 6:791-800. [PMID: 31711931 DOI: 10.1016/j.euf.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/09/2019] [Accepted: 10/17/2019] [Indexed: 12/21/2022]
Abstract
Despite considerable public health initiatives in the past century, there remains a significant gender inequality in life expectancy. The Global Burden of Diseases study has highlighted that the life expectancy for men is 70.5years, compared with 75.6years for women. This discrepancy in mortality appears to be related to a disproportionately higher number of preventable and premature male deaths. Whilst there has been an increased focus on men's health, as evidenced by the establishment of men's health charities and governmental legislation promoting equality, a recent World Health Organization report has highlighted that there is still a prevailing misconception that the higher rate of premature mortality amongst men is a natural phenomenon. We explore the association of male sexual and reproductive health-related diseases and the potential role of a urologist in addressing gender inequality in life expectancy. PATIENT SUMMARY: In this report, we discuss the causes for the gender gap in life expectancy and highlight that men continue to have a higher rate of premature death than women, which is associated with diseases of the male reproductive system. Furthermore, this not only appears to be related to a number of metabolic and lifestyle factors, but may also be the result of the increased risk of cancer in men with sexual and reproductive health-related diseases.
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Attia AA, Abdel‐Hameed AKS, Amer MAEM, Mamdouh H, GamalEl Din SF, El‐Moslemany HEGM. Study of the prevalence and patterns of phosphodiesterase type 5 inhibitor use among sexually active Egyptian males: A National Cross‐sectional Survey. Andrologia 2019; 51:e13364. [DOI: 10.1111/and.13364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Attia Abd‐Allah Attia
- Department of Dermatology, Venereology and Andrology Al‐Azhar University Faculty of Medicine Cairo Egypt
| | | | | | - Hassan Mamdouh
- Department of Dermatology, Venereology and Andrology Al‐Azhar University Faculty of Medicine Cairo Egypt
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24
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Maiuolo J, Gliozzi M, Musolino V, Carresi C, Nucera S, Macrì R, Scicchitano M, Bosco F, Scarano F, Ruga S, Zito MC, Oppedisano F, Mollace R, Paone S, Palma E, Muscoli C, Mollace V. The Role of Endothelial Dysfunction in Peripheral Blood Nerve Barrier: Molecular Mechanisms and Pathophysiological Implications. Int J Mol Sci 2019; 20:ijms20123022. [PMID: 31226852 PMCID: PMC6628074 DOI: 10.3390/ijms20123022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 02/06/2023] Open
Abstract
The exchange of solutes between the blood and the nerve tissue is mediated by specific and high selective barriers in order to ensure the integrity of the different compartments of the nervous system. At peripheral level, this function is maintained by the Blood Nerve Barrier (BNB) that, in the presence, of specific stressor stimuli can be damaged causing the onset of neurodegenerative processes. An essential component of BNB is represented by the endothelial cells surrounding the sub-structures of peripheral nerves and increasing evidence suggests that endothelial dysfunction can be considered a leading cause of the nerve degeneration. The purpose of this review is to highlight the main mechanisms involved in the impairment of endothelial cells in specific diseases associated with peripheral nerve damage, such as diabetic neuropathy, erectile dysfunction and inflammation of the sciatic nerve.
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Affiliation(s)
- Jessica Maiuolo
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Micaela Gliozzi
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Vincenzo Musolino
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Cristina Carresi
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Saverio Nucera
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
| | - Roberta Macrì
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Miriam Scicchitano
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
| | - Francesca Bosco
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Federica Scarano
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
| | - Stefano Ruga
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
| | - Maria Caterina Zito
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
| | - Francesca Oppedisano
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Rocco Mollace
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Sara Paone
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Ernesto Palma
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
| | - Carolina Muscoli
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Via di Valcannuta 247, 00133 Rome, Italy.
| | - Vincenzo Mollace
- Interregional Research Center for Food Safety and Health (IRC-FSH), Department of Health Sciences, University "Magna Græcia" of Catanzaro, Campus Universitario di Germaneto, 88100 Catanzaro, Italy.
- Nutramed Societa' Consortile A Responsabilita' Limitata (S.c.a.r.l.), Complesso Ninì Barbieri, Roccelletta di Borgia, 88021 Catanzaro, Italy.
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Via di Valcannuta 247, 00133 Rome, Italy.
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25
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Zhong BL, Xu YM, Xie WX, Lu J. Cigarette Smoking Is Significantly Linked to Sexual Dissatisfaction in Chinese Heroin-Dependent Patients Receiving Methadone Maintenance Treatment. Front Psychiatry 2019; 10:306. [PMID: 31178762 PMCID: PMC6538806 DOI: 10.3389/fpsyt.2019.00306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/17/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Cigarette smoking is associated with sexual dysfunction in the general population. Both smoking and sexual dysfunction are common in heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT), but their association in MMT HDPs is rarely studied. This study examined the association between smoking and sexual dissatisfaction in Chinese HDPs receiving MMT. Methods: In total, 480 Chinese HDPs, who had sex with their regular or irregular sex partners within one month prior to the study, were included from three MMT clinics in Wuhan, China. Sexual dissatisfaction was assessed with one single question. Socio-demographic and clinical data and smoking characteristics were collected with a standardized questionnaire. Multiple binary logistic regression was used to analyze the association between smoking and sexual dissatisfaction, as well as the associations between levels of smoking and nicotine dependence and sexual dissatisfaction. Results: The prevalence of current smoking was 95.6% in HDPs receiving MMT. Rates of sexual dissatisfaction were higher in current smokers than non-smokers (32.9% vs. 14.3%) with a borderline significant P value of 0.074. After adjusting potential socio-demographic and clinical confounders, current smoking was significantly linked to sexual dissatisfaction (OR = 1.95, P = 0.026), and heavy smoking and severe nicotine dependence were significantly linked to sexual dissatisfaction (OR = 1.80, P = 0.025; OR = 3.27, P < 0.001). Conclusion: Smoking is significantly associated with sexual dysfunction in HDPs receiving MMT. It deserves further investigation as to whether quitting smoking can improve the sexual function of methadone-maintained patients.
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Affiliation(s)
- Bao-Liang Zhong
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China.,Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Min Xu
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Wu-Xiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Jin Lu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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26
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Li J, Wu Q, Wu XK, Zhou ZM, Fu P, Chen XH, Yan Y, Wang X, Yang ZW, Li WL, Stener-Victorin E, Legro RS, Ng EHY, Zhang H, Mol BWJ, Wang CC. Effect of exposure to second-hand smoke from husbands on biochemical hyperandrogenism, metabolic syndrome and conception rates in women with polycystic ovary syndrome undergoing ovulation induction. Hum Reprod 2018; 33:617-625. [PMID: 29471520 DOI: 10.1093/humrep/dey027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jian Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, 26 Heping Road, Harbin, China
| | - Q Wu
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Xiao-Ke Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, 26 Heping Road, Harbin, China
| | - Zhong-Ming Zhou
- Department of Obstetrics and Gynecology, Hubei Province Hospital of Chinese Medicine, Wuhan, China
| | - Ping Fu
- Department of Gynecology, Hangzhou City Hospital of Chinese Medicine, Hangzhou, China
| | - Xiu-Hua Chen
- Department of Gynecology, Department of Traditional Technology, Guangdong Province Hospital of Chinese Medicine, Guangzhou, China
| | - Ying Yan
- Department of Gynecology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xin Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Liaoning University of Chinese Medicine, Shenyang, China
| | - Zheng-Wang Yang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, China
| | - Wei-Li Li
- Department of Obstetrics and Gynecology, Affiliated Hospital, Anhui University of Chinese Medicine, Hefei, China
| | | | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, USA
| | - Ernest Hung-Yu Ng
- Department of Obstetrics and Gynecology, The University of Hong Kong, Hong Kong
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Reproduction and Development Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong
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27
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Esakky P, Hansen DA, Drury AM, Felder P, Cusumano A, Moley KH. Testicular cells exhibit similar molecular responses to cigarette smoke condensate ex vivo and in vivo. FASEB J 2017; 32:63-72. [PMID: 28842431 DOI: 10.1096/fj.201700405r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/14/2017] [Indexed: 12/24/2022]
Abstract
Male exposure to cigarette smoke is associated with seminal defects and with congenital anomalies and childhood cancers in offspring. In mice, paternal exposure to cigarette smoke condensate (CSC) causes molecular defects in germ cells and phenotypic effects in their offspring. Here we used an ex vivo testicular explant model and in vivo exposure to determine the concentration at which CSC impairs spermatogenesis and offspring development. We explanted testis tissue at postnatal day (P)5.5 and cultured it until P11.5. Assessment of growth parameters by analyzing expression of cell-specific markers revealed that the explant system maintained structural and functional integrity. We exposed the P5.5 to -11.5 explants to various concentrations (40-160 µg/ml) of CSC and confirmed that nicotine in the CSC was metabolized to cotinine. We assessed various growth and differentiation parameters, as well as testosterone production, and observed that many spermatogenesis features were impaired at 160 µg/ml CSC. The same parameters were impaired by a similar CSC concentration in vivo Finally, females mated to males that were exposed to 160 µg/ml CSC neonatally had increased rates of pup resorption. We conclude that male exposure to CSC impairs offspring development and that the concentration at which CSC impairs spermatogenesis is similar in vivo and ex vivo. Given that the concentrations of CSC we used contained similar doses of nicotine as human smokers are exposed to, we argue that our model mimics human male reproductive effects of smoking.-Esakky, P., Hansen, D. A., Drury, A. M., Felder, P., Cusumano, A., Moley, K. H. Testicular cells exhibit similar molecular responses to cigarette smoke condensate ex vivo and in vivo.
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Affiliation(s)
- Prabagaran Esakky
- Reasearch and Development, Department of Veterans Affairs Medical Center, St. Louis, Missouri, USA; .,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Deborah A Hansen
- Reasearch and Development, Department of Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - Andrea M Drury
- Reasearch and Development, Department of Veterans Affairs Medical Center, St. Louis, Missouri, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul Felder
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrew Cusumano
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelle H Moley
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
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28
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Hackett G, Krychman M, Baldwin D, Bennett N, El-Zawahry A, Graziottin A, Lukasiewicz M, McVary K, Sato Y, Incrocci L. Coronary Heart Disease, Diabetes, and Sexuality in Men. J Sex Med 2017; 13:887-904. [PMID: 27215685 DOI: 10.1016/j.jsxm.2016.01.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 12/30/2022]
Abstract
Erectile dysfunction (ED) has been well recognized as a marker of increased cardiovascular risk for more than 15 years, especially in younger men. Early detection of ED represents an opportunity to intervene to decrease the risk of future cardiovascular events and limit the progression of ED severity. Evidence suggests there is a window of opportunity of 3 to 5 years from the onset of ED to subsequent cardiovascular events. This opportunity is usually missed if the onus is placed on the patient to seek care for his sexual problems. Unfortunately, these clear messages have not been incorporated into routine cardiovascular care. The reasons for these disparities within specialties are discussed in this article, in addition to management algorithms. Lifestyle modification is usually recommended as the first-line treatment to correct ED and lessen cardiovascular risk, but evidence suggests that this might be effective only in men without established cardiovascular comorbidities. In men with type 2 diabetes mellitus and established cardiovascular disease, lifestyle modification alone is unlikely to be effective. Cardiovascular medications are often associated with sexual dysfunction but changes in medication are more likely to be beneficial in men with milder recent-onset ED. A balanced view must be taken related to medication adverse events, taking into account optimal management of established cardiovascular disease. Testosterone deficiency has been associated with different metabolic disorders, especially metabolic syndrome and type 2 diabetes mellitus. Testosterone deficiency syndrome has been associated with an independent burden on sexual function globally and increased cardiovascular and all-cause mortality. Testosterone replacement therapy has been shown to improve multiple aspects of sexual function and, in some studies, has been associated with a decrease in mortality, especially in men with type 2 diabetes mellitus. Recent studies have suggested that phosphodiesterase type 5 inhibitors, the first-line medications to treat ED, could decrease cardiovascular and all-cause mortality, through multiple mechanisms, predominantly related to improved endothelial function.
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Affiliation(s)
| | - Michael Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, USA
| | - David Baldwin
- Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nelson Bennett
- Department of Urology, Lahey Hospital, Burlington, MA, USA
| | - Ahmed El-Zawahry
- Division of Urology, SIU School of Medicine, Springfield, IL, USA
| | | | | | - Kevin McVary
- Division of Urology, SIU School of Medicine, Springfield, IL, USA
| | - Yoshikazu Sato
- Department of Urology, Sanjukai Hospital, Sapporo, Japan
| | - Luca Incrocci
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
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29
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DeLay KJ, Haney N, Hellstrom WJ. Modifying Risk Factors in the Management of Erectile Dysfunction: A Review. World J Mens Health 2016; 34:89-100. [PMID: 27574592 PMCID: PMC4999494 DOI: 10.5534/wjmh.2016.34.2.89] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 12/16/2022] Open
Abstract
Erectile dysfunction (ED) is prevalent among men and its presence is often an indicator of systemic disease. Risk factors for ED include cardiovascular disease, hypertension, diabetes mellitus (DM), tobacco use, hyperlipidemia, hypogonadism, lower urinary tract symptoms, metabolic syndrome, and depression. Addressing the modifiable risk factors frequently improves a patient's overall health and increases lifespan. The literature suggests that smoking cessation, treatment of hyperlipidemia, and increasing physical activity will improve erectile function in many patients. How the treatment of DM, depression, and hypogonadism impacts erectile function is less clear. Clinicians need to be aware that certain antihypertensive agents can adversely impact erectile function. The treatment of men with ED needs to address the underlying risk factors to ameliorate the disease process.
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Affiliation(s)
- Kenneth J DeLay
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Nora Haney
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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30
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Maiorino MI, Bellastella G, Esposito K. Lifestyle modifications and erectile dysfunction: what can be expected? Asian J Androl 2016; 17:5-10. [PMID: 25248655 PMCID: PMC4291878 DOI: 10.4103/1008-682x.137687] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Erectile dysfunction (ED) is a common medical disorder whose prevalence is increasing worldwide. Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome, and excessive alcohol consumption. Quite interestingly, all these metabolic conditions are strongly associated with a pro-inflammatory state that results in endothelial dysfunction by decreasing the availability of nitric oxide (NO), which is the driving force of the blood genital flow. Lifestyle and nutrition have been recognized as central factors influencing both vascular NO production, testosterone levels, and erectile function. Moreover, it has also been suggested that lifestyle habits that decrease low-grade clinical inflammation may have a role in the improvement of erectile function. In clinical trials, lifestyle modifications were effective in ameliorating ED or restoring absent ED in people with obesity or metabolic syndrome. Therefore, promotion of healthful lifestyles would yield great benefits in reducing the burden of sexual dysfunction. Efforts, in order to implement educative strategies for healthy lifestyle, should be addressed.
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Affiliation(s)
| | | | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, via Pansini n° 5, Naples, Italy
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31
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Abstract
Erectile dysfunction (ED) is a common condition affecting millions of men worldwide. The pathophysiology and epidemiologic links between ED and risk factors for cardiovascular disease (CVD) are well-established. Lifestyle modifications such as smoking cessation, weight reduction, dietary modification, physical activity, and psychological stress reduction have been increasingly recognized as foundational to the prevention and treatment of ED. The aim of this review is to outline behavioral choices which may increase ones risk of developing ED, to present relevant studies addressing lifestyle factors correlated with ED, and to highlight proposed mechanisms for intervention aimed at improving erectile function in men with ED. These recommendations can provide a framework for counseling patients with ED about lifestyle modification.
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Affiliation(s)
- Marah C Hehemann
- 1 Department of Urology, Loyola University Health Systems, Maywood, IL, USA ; 2 Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - James A Kashanian
- 1 Department of Urology, Loyola University Health Systems, Maywood, IL, USA ; 2 Department of Urology, Weill Cornell Medicine, New York, NY, USA
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32
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Abstract
Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man's quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner's sexual experience and the couple's quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.
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33
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Harlev A, Agarwal A, Gunes SO, Shetty A, du Plessis SS. Smoking and Male Infertility: An Evidence-Based Review. World J Mens Health 2015; 33:143-60. [PMID: 26770934 PMCID: PMC4709430 DOI: 10.5534/wjmh.2015.33.3.143] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/17/2015] [Accepted: 08/19/2015] [Indexed: 12/14/2022] Open
Abstract
Many studies have reported that the contents of cigarette smoke negatively affect sperm parameters, seminal plasma, and various other fertility factors. Nevertheless, the actual effect of smoking on male fertility is not clear. The effect of smoking on semen parameters is based on the well-established biological finding that smoking increases the presence of reactive oxygen species, thereby resulting in oxidative stress (OS). OS has devastating effects on sperm parameters, such as viability and morphology, and impairs sperm function, hence reducing male fertility. However, not all studies have come to the same conclusions. This review sheds light upon the arguable association between smoking and male fertility and also assesses the impact of non-smoking routes of tobacco consumption on male infertility. It also highlights the evidence that links smoking with male infertility, including newly emerging genetic and epigenetic data, and discusses the clinical implications thereof.
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Affiliation(s)
- Avi Harlev
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.; Fertility and In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sezgin Ozgur Gunes
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.; Department of Medical Biology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Amit Shetty
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Stefan Simon du Plessis
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.; Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Abstract
INTRODUCTION Erectile dysfunction (ED) has been significantly associated with many chronic conditions including obesity, the metabolic syndrome, hypogonadism, diabetes mellitus, cardiovascular disease (CVD), lower urinary tract symptoms, and psychiatric/psychological disorders. ED is also a well-established predictor of CVD. AIM This review will focus on the association of ED with cardiovascular, metabolic, and cognitive conditions and discuss the effects of managing lifestyle factors in order to reduce the burden of ED and consequently outcomes in patients with chronic conditions. METHODS A literature search using Medline, PubMed (U.S. National Library of Medicine and the National Institutes of Health), and abstracts from scientific meetings was performed from 1990. MAIN OUTCOME MEASURES Main outcome measures were improvements in sexual function. RESULTS A total of 59 reviews on the topic were evaluated. CONCLUSIONS Targeting several lifestyle factors associated with CVD/metabolic/cognitive disorders, e.g., smoking, alcohol consumption, obesity, and physical activity, can have significant benefits, leading to an improvement in ED as well as testosterone levels and consequently CVD. Kirby M. The circle of lifestyle and erectile dysfunction. Sex Med Rev 2015;3:169-182.
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Affiliation(s)
- Michael Kirby
- The Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, Herts, UK; The Prostate Centre, London, UK.
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The Link Between Cigarette Smoking and Erectile Dysfunction: A Systematic Review. Eur Urol Focus 2015; 1:39-46. [DOI: 10.1016/j.euf.2015.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/08/2015] [Accepted: 01/15/2015] [Indexed: 11/22/2022]
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Kovac JR, Labbate C, Ramasamy R, Tang D, Lipshultz LI. Effects of cigarette smoking on erectile dysfunction. Andrologia 2014; 47:1087-92. [PMID: 25557907 DOI: 10.1111/and.12393] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2014] [Indexed: 11/27/2022] Open
Abstract
Cigarette smoking is a leading cause of preventable morbidity and mortality in the United States. Although public policies have resulted in a decreased number of new smokers, smoking rates remain stubbornly high in certain demographics with 20% of all American middle-aged men smoking. In addition to the well-established harmful effects of smoking (i.e. coronary artery disease and lung cancer), the past three decades have led to a compendium of evidence being compiled into the development of a relationship between cigarette smoking and erectile dysfunction. The main physiologic mechanism that appears to be affected includes the nitric oxide signal transduction pathway. This review details the recent literature linking cigarette smoking to erectile dysfunction, epidemiological associations, dose dependency and the effects of smoking cessation on improving erectile quality.
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Affiliation(s)
| | - C Labbate
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - R Ramasamy
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - D Tang
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L I Lipshultz
- Department of Urology and The Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Fafiolu AS, Adebayo AM, Akande TO, Akinboboye OO. Erectile dysfunction among male hypertensives in a tertiary health facility in South-West Nigeria. Glob J Health Sci 2014; 7:154-60. [PMID: 25560353 PMCID: PMC4796473 DOI: 10.5539/gjhs.v7n1p154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/03/2014] [Accepted: 07/20/2014] [Indexed: 01/27/2023] Open
Abstract
Introduction: Erectile dysfunction (ED) has been associated with hypertension and some other chronic diseases. There are few studies on ED in Nigerian male hypertensives and ED appears to be under-reported. We sought to determine the prevalence of ED among hypertensive and normotensive men and to assess the association of demographics, hypertension, antihypertensive medications and other risk factors with erectile function. Methods: A comparative cross sectional study was conducted among male adult hypertensive and normotensive patients attending the outpatient clinic of a tertiary hospital in South-West Nigeria. A systematic random sampling method was employed for the selection of respondents. Participants were interviewed using a semi-structured questionnaire to document socio-demographic data, medical history, social history and degree of ED. Demographic and anthropometric characteristics was obtained from all participants. The International Index of Sexual Health Inventory for men (SHIM) was used to determine the presence and severity of ED. Association between categorical independent variables and erectile function were tested using Chi square and the predictors of erectile dysfunction determined with binary logistic regression model at 5% level of significance. Results: A total of 202 male patients completed the study (101 with established hypertension and 101 normotensives who served as comparative group). The mean age of the respondents was 49.74 ± 16.6 years. A total of 133 (65.8%) respondents had ED in varying severities while 34.2% had normal erectile function. Mild to moderate ED occurred in 29.7% while 36.1% had severe ED. On bivariate analysis, prevalence of ED was higher among hypertensives (75%) than normotensives (56.9%) and this was statistically significant, p = 0.007. On multivariate analysis, the only significant risk factor for ED was age. The elderly aged ≥ 65 years (OR: 2.9; 95% CI: 1.03–8.35; p = 0.04) and those aged 46–64 years (OR: 2.9; 95% CI: 1.38–6.53; p = 0.006) were 3 times each more likely to have erectile dysfunction compared with those aged ≤ 45 years. Conclusion: This study revealed that erectile dysfunction was prevalent in both hypertensive and normotensive population studied and that this was significantly worse with increasing age. A higher proportion of hypertensives compared to normotensives had erectile dysfunction. We recommend that all men presenting to a physician should have routine evaluation for ED so as to recognise it early and reduce its effects.
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Implication of Cigarette Smoking and Cessation on Sexual Function in Men and Women. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0028-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Weber MF, Smith DP, OˈConnell DL, Patel MI, Souza PL, Sitas F, Banks E. Risk factors for erectile dysfunction in a cohort of 108 477 Australian men. Med J Aust 2013; 199:107-11. [DOI: 10.5694/mja12.11548] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/06/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | - David P Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW
| | | | - Manish I Patel
- Discipline of Surgery, University of Sydney, Westmead, NSW
| | | | - Freddy Sitas
- Cancer Research Division, Cancer Council NSW, Sydney, NSW
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
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Alberti L, Torlasco C, Lauretta L, Loffi M, Maranta F, Salonia A, Margonato A, Montorsi F, Fragasso G. Erectile dysfunction in heart failure patients: a critical reappraisal. Andrology 2013; 1:177-91. [PMID: 23339018 DOI: 10.1111/j.2047-2927.2012.00048.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/15/2012] [Accepted: 11/19/2012] [Indexed: 12/31/2022]
Abstract
Heart failure (HF) is a complex clinical syndrome with a constantly increasing incidence and prevalence in western countries. Total absence of sexual activity is registered in 30% of HF patients. Moreover, HF-induced reduction in exercise tolerance, side effects of HF medications and the coexistence of shared risk factors between HF and sexual dysfunction may further aggravate the sexual health of HF patients. The purpose of this review is to examine the pathophysiological mechanisms behind the association of erectile dysfunction (ED) and HF, the potential therapeutic approaches and the eventual indications for sexual activity in HF patients. Medline and Cochrane Library search was performed from January 1970 through October 2012 to retrieve relevant papers outlining the association between ED and HF. Many evidences have outlined a tight association between ED and HF pathophysiological standpoint. Shared risk factors, common pathogenic traits and epidemiologic association represent some of the links between these conditions. Erectile dysfunction has been recognized as an earlier predictor of cardiovascular events; moreover, HF itself may cause and/or worsen ED because of its particular feature and co-morbidities. Furthermore, some cardiovascular drugs may contribute to impaired erectile function. In stable patients with stable HF, sexual activity is generally not contraindicated but it should be encouraged, as a form of moderate-intensity physical exertion. An effective treatment of ED in HF patients should be founded on the correction of reversible risk factors, on the choice of cardiovascular drugs with the lowest effect upon patient's erectile function, and on the use of phosphodiesterase-5-inhibitors. Physicians should be aware of the close relation between HF and ED and of the related clinical and therapeutic implications, in order to improve patients quality of life and clinical outcome.
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Affiliation(s)
- L Alberti
- Heart Failure Clinic, Ospedale San Raffaele, Milano, Italy
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Glina S, Sharlip ID, Hellstrom WJ. Modifying Risk Factors to Prevent and Treat Erectile Dysfunction. J Sex Med 2013; 10:115-9. [DOI: 10.1111/j.1743-6109.2012.02816.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Corona G, Mondaini N, Ungar A, Razzoli E, Rossi A, Fusco F. Phosphodiesterase type 5 (PDE5) inhibitors in erectile dysfunction: the proper drug for the proper patient. J Sex Med 2011; 8:3418-32. [PMID: 21995676 DOI: 10.1111/j.1743-6109.2011.02473.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a very common multidimensional disorder affecting men worldwide. Physical illness, reaction to life stresses, or an unhappy couple relationship influence clinical outcome. Phosphodiesterase type 5 (PDE5) inhibitors are recognized as efficacious and well tolerated, and are the first-line treatment for ED. Sildenafil, tadalafil, and vardenafil are the most widely used and studied PDE5 inhibitors. Data acquired during a routine diagnostic workup for ED should be taken into account when choosing the best PDE5 inhibitor for the individual patient, creating an individualized treatment plan, and going beyond "experience-based" subjective opinion and unfounded ideas and prejudice regarding currently available drugs. AIM As the process of matching a given patient's profile to any selected PDE5 inhibitor often relies more on physician's personal convictions than on solid evidence, the aim of this review is to identify the main clinical, demographic, and relational factors influencing the choice of the PDE5 inhibitor to be used for the treatment of ED. METHODS A systematic literature search and current treatment guidelines were evaluated in a systematic manner. MAIN OUTCOME MEASURES The main clinical, cultural, and demographical factors to be considered for the treatment of ED have been identified. RESULTS Main factors influencing the choice of the treatment for ED have been described. A short list of items that may help in choosing the right PDE5 inhibitor for the treatment of different patients in daily clinical practice has been prepared. CONCLUSIONS The simple algorithms prepared should be a useful tool to be used in daily practice, which may help in choosing the right treatment for each subject affected by ED.
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Affiliation(s)
- Giovanni Corona
- Andrology and Sexual Medicine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Chan SSC, Leung DYP, Abdullah ASM, Lo SST, Yip AWC, Kok WM, Ho SY, Lam TH. Smoking-cessation and adherence intervention among Chinese patients with erectile dysfunction. Am J Prev Med 2010; 39:251-8. [PMID: 20709257 DOI: 10.1016/j.amepre.2010.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 03/12/2010] [Accepted: 05/07/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whether the association between smoking and erectile dysfunction is causal is uncertain. No RCTs have been previously conducted on cessation counseling and additional nicotine replacement therapy (NRT) adherence counseling among smokers with erectile dysfunction. PURPOSE The aim of the study was to determine if smoking-cessation counseling in conjunction with NRT increases quitting and NRT adherence compared to usual care, and if stopping smoking would improve erectile function among Chinese erectile dysfunction patients who smoke. DESIGN An RCT was conducted. Data were collected in 2004-2007 and analyzed in 2008. SETTING/PARTICIPANTS The sample included 719 Chinese adult erectile dysfunction patients who smoked at least 1 cigarette per day, intended to quit smoking within the next 7 days, and would use NRT. INTERVENTIONS Group A1 received 15-minute smoking-cessation and 3-minute NRT adherence counseling at baseline, 1 week, and 4 weeks with free NRT for 2 weeks. Group A2 received the same treatment, except for the adherence counseling. Group B received 10 minutes of quitting advice. All subjects received a self-help quitting booklet at first contact. MAIN OUTCOME MEASURES Self-reported 7-day tobacco abstinence at 6 months, 4-week NRT adherence at 1 month, and improvement in erectile dysfunction condition at 6 months. RESULTS The intervention groups (A1+A2) achieved higher rates of abstinence, both self-reported (23% vs 12.8%, RR=1.79, 95% CI=1.22, 2.62) and biochemically validated (11.4% vs 5.5%, RR=2.07, 95% CI=1.13, 3.77), than the control group. The NRT adherence rate did not differ between Groups A1 and A2 (13.7% vs 12.7%, RR=1.08, 95% CI=0.69, 1.69). An improvement in erectile dysfunction status from baseline to 6 months was associated with self-reported quitting at 6 months but not with intervention status. CONCLUSIONS Although quitting smoking was associated with improvement in erectile dysfunction, this study found significant outcome differences among the means used to achieve smoking cessation. TRIAL REGISTRATION ISRCTN13070778.
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Affiliation(s)
- Sophia S C Chan
- Department of Nursing Studies, The University of Hong Kong, Hong Kong
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Gratzke C, Angulo J, Chitaley K, Dai YT, Kim NN, Paick JS, Simonsen U, Uckert S, Wespes E, Andersson KE, Lue TF, Stief CG. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med 2010; 7:445-75. [PMID: 20092448 DOI: 10.1111/j.1743-6109.2009.01624.x] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Significant scientific advances during the past 3 decades have deepened our understanding of the physiology and pathophysiology of penile erection. A critical evaluation of the current state of knowledge is essential to provide perspective for future research and development of new therapies. AIM To develop an evidence-based, state-of-the-art consensus report on the anatomy, physiology, and pathophysiology of erectile dysfunction (ED). METHODS Consensus process over a period of 16 months, representing the opinions of 12 experts from seven countries. MAIN OUTCOME MEASURE Expert opinion was based on the grading of scientific and evidence-based medical literature, internal committee discussion, public presentation, and debate. RESULTS ED occurs from multifaceted, complex mechanisms that can involve disruptions in neural, vascular, and hormonal signaling. Research on central neural regulation of penile erection is progressing rapidly with the identification of key neurotransmitters and the association of neural structures with both spinal and supraspinal pathways that regulate sexual function. In parallel to advances in cardiovascular physiology, the most extensive efforts in the physiology of penile erection have focused on elucidating mechanisms that regulate the functions of the endothelium and vascular smooth muscle of the corpus cavernosum. Major health concerns such as atherosclerosis, hyperlipidemia, hypertension, diabetes, and metabolic syndrome (MetS) have become well integrated into the investigation of ED. CONCLUSIONS Despite the efficacy of current therapies, they remain insufficient to address growing patient populations, such as those with diabetes and MetS. In addition, increasing awareness of the adverse side effects of commonly prescribed medications on sexual function provides a rationale for developing new treatment strategies that minimize the likelihood of causing sexual dysfunction. Many basic questions with regard to erectile function remain unanswered and further laboratory and clinical studies are necessary.
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Affiliation(s)
- Christian Gratzke
- Department of Urology, Ludwig-Maximilians-Universität, München, Germany
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Relative contributions of modifiable risk factors to erectile dysfunction: results from the Boston Area Community Health (BACH) Survey. Prev Med 2010; 50:19-25. [PMID: 19944117 PMCID: PMC2813912 DOI: 10.1016/j.ypmed.2009.11.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/13/2009] [Accepted: 11/18/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this study was to determine the relative contribution of modifiable risk factors (physical activity, smoking, and alcohol consumption) to inter-subject variation in erectile dysfunction (ED). METHODS The Boston Area Community Health (BACH) Survey used a multistage stratified random sample to recruit 2301 men age 30-79 years from the city of Boston between 2002 and 2005. ED was assessed using the 5-item International Index of Erectile Function (IIEF-5). Multiple linear regression models and R(2) were used to determine the proportion of the variance explained by modifiable risk factors. RESULTS In unadjusted analyses, lifestyle factors accounted for 12.2% of the inter-subject variability in IIEF-5 scores, comparable to the proportion explained by comorbid conditions (14.7%) and socioeconomic status (9%). Lifestyle factors were also significantly associated with age, comorbid conditions and socioeconomic status (SES). A multivariate model including all covariates associated with ED explained 29% of the variance, with lifestyle factors accounting for 0.9% over and above all other covariates in the model. Analyses repeated in a subgroup of 1215 men without comorbid conditions show lifestyle factors accounting for 2.5% of the variance after accounting for all other variables in the model. CONCLUSIONS Results of the present study demonstrate the contribution of modifiable lifestyle factors to the prevalence of ED. These results suggest a role for behavior modification in the prevention of ED.
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Salem S, Abdi S, Mehrsai A, Saboury B, Saraji A, Shokohideh V, Pourmand G. Erectile Dysfunction Severity as a Risk Predictor for Coronary Artery Disease. J Sex Med 2009; 6:3425-32. [DOI: 10.1111/j.1743-6109.2009.01515.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Inman BA, Sauver JLS, Jacobson DJ, McGree ME, Nehra A, Lieber MM, Roger VL, Jacobsen SJ. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 2009; 84:108-13. [PMID: 19181643 PMCID: PMC2664580 DOI: 10.4065/84.2.108] [Citation(s) in RCA: 305] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the association between erectile dysfunction (ED) and the long-term risk of coronary artery disease (CAD) and the role of age as a modifier of this association. PARTICIPANTS AND METHODS From January 1, 1996, to December 31, 2005, we biennially screened a random sample of 1402 community-dwelling men with regular sexual partners and without known CAD for the presence of ED. Incidence densities of CAD were calculated after age stratification and adjusted for potential confounders by time-dependent Cox proportional hazards models. RESULTS The prevalence of ED was 2% for men aged 40 to 49 years, 6% for men aged 50 to 59 years, 17% for men aged 60 to 69 years, and 39% for men aged 70 years or older. The CAD incidence densities per 1000 person-years for men without ED in each age group were 0.94 (40-49 years), 5.09 (50-59 years), 10.72 (60-69 years), and 23.30 (> or =70 years). For men with ED, the incidence densities of CAD for each age group were 48.52 (40-49 years), 27.15 (50-59 years), 23.97 (60-69 years), and 29.63 (> or =70 years). CONCLUSION ED and CAD may be differing manifestations of a common underlying vascular pathology. When ED occurs in a younger man, it is associated with a marked increase in the risk of future cardiac events, whereas in older men, ED appears to be of little prognostic importance. Young men with ED may be ideal candidates for cardiovascular risk factor screening and medical intervention.
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Affiliation(s)
| | - Jennifer L. St. Sauver
- Individual reprints of this article are not available. Address correspondence to Jennifer L. St. Sauver, PhD, Division of Epidemiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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50
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Kupelian V, Link CL, McKinlay JB. Association between smoking, passive smoking, and erectile dysfunction: results from the Boston Area Community Health (BACH) Survey. Eur Urol 2007; 52:416-22. [PMID: 17383811 PMCID: PMC2139983 DOI: 10.1016/j.eururo.2007.03.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 03/06/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although previous studies report an association between erectile dysfunction (ED) and smoking, few have examined the impact of passive smoke exposure on ED. This analysis examines the association of active and passive smoking and ED and investigates a dose-response effect of smoking. METHODS The Boston Area Community Heath (BACH) survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2301 men, aged 30-79 yr, from the city of Boston. ED was assessed using the five-item International Index of Erectile Function. Smoking and passive smoking were assessed by self-report. Analyses adjusted for sociodemographic and lifestyle factors and important chronic illnesses. RESULTS An association between smoking and ED was observed with a significant trend in increased risk of ED with cumulative pack-years of smoking (adjusted odds ratio [OR]=1.68; 95% confidence interval [CI], 1.03, 2.30 for > or =20 pack-years). Compared to never smokers not exposed to passive smoking, men who never smoked but were exposed to passive smoking had a moderate, statistically nonsignificant, increase in risk of ED (adjusted OR=1.33; 95%CI: 0.69, 2.55) comparable to the OR observed for a cumulative exposure of 10-19 pack-years of active smoking (adjusted OR=1.25; 95%CI, 0.68, 2.30). CONCLUSIONS Results indicate a dose-response association between smoking and ED with a statistically significant effect observed with > or =20 pack-years of exposure. Passive smoking is associated with a small, statistically nonsignificant increase in risk of ED comparable to approximately 10-19 pack-years of active smoking.
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