Erectile Dysfunction and Correlated Factors in Brazilian Men Aged 18–40 years

A Mendelian randomization study on causal effects of leisure sedentary behavior on the risk of erectile dysfunction

BACKGROUND

Erectile dysfunction has been associated with leisure sedentary behavior in several epidemiological and observational studies. However, the interpretation of these findings is difficult due to residual confounding or reverse causality.

OBJECTIVES

To explore the causal association between leisure sedentary behavior and erectile dysfunction, and to explore the underlying mechanism using Mendelian randomization.

MATERIALS AND METHODS

In the present study, publicly available large-scale genome-wide association studies of leisure sedentary behaviors (television watching, computer use, and driving), erectile dysfunction, sex hormones (total testosterone, bioactive testosterone, estradiol, follicle-stimulating hormone, luteinizing hormone, prolactin, and sex hormone binding globulin), biomarkers of endothelial function (C reactive protein, E-selectin, and matrix metalloproteinase 7), and psychiatric symptoms (depression and anxiety) were used to perform two-sample Mendelian randomization analyses. The inverse variance weighting method was the main method used to estimate the association, and sensitivity analyses were also performed.

RESULTS

A greater risk of erectile dysfunction was significantly associated with a higher genetic susceptibility to leisure computer usage (odds ratio = 3.57; 95% confidence interval = 1.78-7.16; p < 0.001). No evidence was obtained to suggest that watching television or driving for leisure increased the risk of erectile dysfunction. No association was found between computer use and depression, anxiety, C reactive protein, E-selectin, matrix metalloproteinase 7, or other sex hormones, with the exception of follicle-stimulating hormone levels (odds ratio = 0.29; 95% confidence interval = 0.12-0.69; p = 0.01). No indication of heterogeneity or pleiotropy was identified by sensitivity analysis.

DISCUSSION

Extended computer usage for leisure raised the likelihood of developing erectile dysfunction, which may be associated to lower follicle-stimulating hormone levels; however, the role of endothelial dysfunction and psychological disorders in the development of erectile dysfunction should not be underestimated. Moderate physical activity may help to correct the dysfunction.

CONCLUSION

The present study offered substantial evidence for a positive causal association between computer use and the risk of erectile dysfunction. However, a definitive causal association needs to be established by further research.

Associations Between Contents of Pornography and Sexual Satisfaction and Function Among Young Adults

Pornography offers a wide variety of sexual contents and has documented potential positive (e.g., higher sexual satisfaction) and negative associations (e.g., lower sexual function) with sexuality. The aims of this study were to describe the proportion of use of five different contents of pornography (i.e. group sex, passion and romance, gender-bending, taboo transgression and forbidden sex, power, control, and rough sex pornography), to examine gender-based differences in the frequency of use of these contents, and to examine the associations between the frequency of use of these contents and sexual satisfaction and function, considering potential differences among genders and individuals with and without a romantic or sexual partner, and controlling for frequency of masturbation. A sample of 827 young adults (503 women; Mage = 23.44) completed online self-report questionnaires. Results of path analysis indicated that, controlling for frequency of masturbation, the use of passion and romance pornography was associated with higher sexual satisfaction, whereas the use of power, control, and rough sex pornography was associated with lower sexual satisfaction. Cisgender men's use of power, control, and rough sex pornography was also associated with lower sexual function. These findings suggest different associations between pornography use and sexual satisfaction and function depending on the pornographic contents used.

Exploring the potential relationships among obstructive sleep apnea, erectile dysfunction, and gut microbiota: a narrative review

INTRODUCTION

Poor sleep quality is closely associated with comorbidities affecting a multitude of organ systems. Among the sleep disorders in the population, there has recently been an increase in the prevalence of obstructive sleep apnea (OSA), which has particularly affected men. The intermittent hypoxia and sleep fragmentation associated with OSA can result in the manifestation or aggravation of a number of pathophysiologic conditions, including the impairment of reproductive function in men and women. In this context, erectile dysfunction (ED) is of particular concern. Other consequences of OSA are changes in the gastrointestinal microbiota, with the resultant dysbiosis having potentially harmful consequences that promote downstream exacerbation of various comorbidities.

OBJECTIVES

This narrative review aims to explore the potential relationships among ED, gut microbiota, and OSA.

METHODS

A search of the relevant literature was performed in the PubMed, Embase, Medline, and Web of Science databases.

RESULTS

Sleep is important for regulating the body's functions, and sleep deprivation can negatively affect health. OSA can damage organic functions, including reproductive function, and can lead to ED. Restoring the microbiota and improving sleep can help to improve sexual function or reverse ED and enhance other associated conditions mediated through the gut-brain axis relationship. Probiotics and prebiotics can be used as supportive strategies in the prevention and treatment of OSA, as they help to reduce systemic inflammation and improve intestinal barrier function.

CONCLUSION

A good diet, a healthy lifestyle, and proper bowel function are essential in controlling depression and several other pathologies. Modulating the gut microbiota through probiotics and prebiotics can provide a viable strategy for developing new therapeutic options in treating many conditions. A better understanding of these a priori unrelated phenomena would foster our understanding of the effects of OSA on human fertility and how changes in gut microbiota may play a role.

Prevalence and associated factors of moderate to severe erectile dysfunction among adult men in Malaysia

Erectile dysfunction (ED) is a pervasive problem among men, often shrouded in silence and stigma. This manuscript analysed the National Health and Morbidity Survey 2019 data to identify the prevalence of moderate to severe ED among men aged 18 and above in Malaysia and describe its associated factors. Self-administered questionnaire on ED utilised a locally validated International Index of Erectile Function. Variables on sociodemographics, risky lifestyles and comorbidities were obtained via an interviewer-administered questionnaire. The prevalence was determined using complex sampling analysis, and logistic regression was used to determine the associated factors of ED. A sample of 2403 men aged ≥ 18 participated, with a moderate to severe ED prevalence was 31.6% (95% CI 28.8, 34.6). The mean (± SD) of the total score of IIEF-5 for overall respondents was 18.16 (± 4.13). Multiple logistic regression analysis revealed a significant association between moderate to severe ED among men aged 60 years and above, single or divorcee, men without formal, primary, and secondary education, non-government employees, unemployed, and retiree, as well as physically inactive men. Focused public health interventions are necessary to improve education in sexual health, increase health promotion programs, and promote healthy ageing across the population.

Effect of internet pornography use frequency on psychogenic erectile dysfunction severity in young Turkish men: the mediating role of dyadic adjustment

This cross-sectional study aimed to investigate the effect of the frequency of using pornography on psychogenic erectile dysfunction severity after controlling for other psychological factors. It then evaluated the mediating role of dyadic adjustment regarding this. This study included 66 young married heterosexual male patients who were diagnosed with psychogenic erectile dysfunction after organic causes were excluded. The patients filled out the form about demographics, the age of onset of pornography use, and the frequency of pornography use. All participants were evaluated using a comprehensive data form, the International Index of Erectile Function, the Dyadic Adjustment Scale, the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms, the Perceived Stress Scale, and the Rosenberg Self-Esteem Scale. A significant strong negative correlation was determined between the International Index of Erectile Function scores and pornography use frequency (r = -0.535 and p < 0.001). Pornography use frequency and Dyadic Adjustment Scale scores were found to have a significant predictive effect on erectile dysfunction scores in hierarchical regression analysis after controlling for somatization, depression, and perceived stress, which are typically correlated with erectile dysfunction scores (Beta = -0.28, and 0.34 respectively, p = 0.02, and 0.01 respectively). The Sobel test conducted to evaluate the mediating effect of dyadic adjustment revealed that dyadic adjustment played a mediating role in the correlation between pornography use frequency and erectile dysfunction scores (z = -1.988 and p = 0.047, respectively). The most significant observation of this study was the specific causative effect of pornography use frequency on erectile dysfunction severity through dyadic adjustment, especially considering that the frequency of using pornography is a modifiable factor.

Poor sleep quality and erectile dysfunction in students from a Peruvian University: A cross-sectional study

Objective

We aimed to evaluate the association between sleep quality and erectile dysfunction in young university students.

Methods

A cross-sectional survey was conducted in men aged 18-30 years from Universidad Ricardo Palma, Lima, Peru. The survey comprised the International Index of Erectile Function, Pittsburgh Sleep Quality Index, Berlin questionnaire, and questions related to sociodemographic data. Prevalence ratios were estimated with generalized linear models.

Results

Of 381 participants, the median age was 23 years. Half of the students (50.9%) had poor sleep quality, of which 72.7% had mild erectile dysfunction and 20.6% mild to moderate dysfunction. Prevalence of erectile dysfunction was significantly higher in students with poor sleep quality than in students with good sleep quality (aPR = 6.48; 95% CI: 4.58-9.17) after adjusting for age, academic year, nutritional status, and sleep apnea. In a subsequent exploratory analysis, sleep apnea was associated with a higher prevalence of erectile dysfunction (aPR = 1.19; 95% CI: 1.01-1.39), while overweight (aPR = 0.85; 95% CI: 0.76-0.95) and obesity (aPR = 0.65; 95% CI: 0.52-0.82) were associated with a lower prevalence of this condition.

Conclusion

Poor sleep quality was independently associated with erectile dysfunction in young university students. This finding suggests that male students are at risk for sexual problems due to possible academic demands and relationship issues.

Premature ejaculation among Chinese urban men: prevalence and correlates

Background

Premature ejaculation (PE) is a common male sexual dysfunction worldwide. It leads to substantial distress in men and their partners, constitutes a serious threat to the quality and stability of romantic relationships, and results in a decreased quality of life in a large part of the population.

Aim

We investigated the prevalence of PE and correlated factors in an urban sample of Chinese men.

Methods

In total, 1976 Chinese men aged 18 to 50 years responded to an online questionnaire regarding background information, present and previous sexual experience, frequency of different types of sex, as well as erectile and ejaculatory function.

Outcomes

Participants’ age, assigned sex at birth, sexual identity, relationship status, present and previous sexual experience, frequency of sexual activities, International Index of Erectile Function–5, and Checklist for Early Ejaculation Symptoms were used in the analyses.

Results

Forty-four (2.3%) participants had scores that were indicative or strongly indicative of PE, which was highly correlated with erectile problems. Men with more sexual experience (ie, more sexual partners and longer duration of being sexually active) had fewer ejaculatory problems. More frequent masturbation was associated with ejaculatory problems when controlling for age and education. More frequent partnered sex (ie, penile-vaginal sex) was associated with fewer ejaculatory problems. Ejaculation latency times for different types of sexual activities were positively correlated.

Clinical Translation

The results indicated that ejaculatory problems have complex relationships with sexual experience that clinicians should be aware of.

Strengths and Limitations

This study was the first to investigate PE with the Checklist for Early Ejaculation Symptoms as the measurement tool and the associations between PE and sexual experience, frequency of sexual activities, and sexual function in a large Chinese sample. However, self-reported ejaculation latency times may suffer from problems with validity.

Conclusion

Men’s sexual experience (ie, more sexual partners and longer duration of being sexually active) has an effect on their sexual function, which in turn affects their sexual activity.

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

Introduction

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

Aim

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

Methods

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

Main Outcome Measures

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

Results

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

Clinical Implications

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

Strengths & Limitations

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

Conclusion

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

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

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

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

Association Among Lower Urinary Tract Symptoms, Erectile Function, and Sexual Satisfaction: Results from the Brazil LUTS Study

INTRODUCTION

Lower urinary tract symptoms (LUTS) affect ≥60% of adult men and are associated with erectile dysfunction (ED) and sexual dissatisfaction.

AIM

The aim of this study was to evaluate the relationship among male LUTS, ED, and sexual satisfaction.

METHODS

This was a secondary analysis of the Brazil LUTS study, a cross-sectional, epidemiological survey conducted by telephone interview in 5 cities in Brazil. This analysis included men aged ≥40 years.

MAIN OUTCOME MEASURE

LUTS were identified using International Continence Society definitions. LUTS severity was assessed using the International Prostate Symptom Score questionnaire. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire and sexual satisfaction was rated on a 5-point scale.

RESULTS

2,433 men participated in the study. Of 2,183 men reporting data on LUTS, 873 (40%) had LUTS "about half the time" or more. The prevalence of ED and sexual dissatisfaction was 14.4% and 7.8%, respectively. The proportion of men reporting ED and sexual dissatisfaction was higher among men with LUTS (24.6% and 13.8%, respectively) than men without LUTS (8.7% and 4.5%, respectively; P < .001). LUTS severity was negatively correlated with IIEF-5 scores (r = -0.199; P < .001); we estimated a 0.431-point decrease in IIEF-5 score per 3-point increase in International Prostate Symptom Score. Increased age and the presence of LUTS were associated with a greater chance of ED and sexual dissatisfaction; depression/anxiety and diabetes were associated with a greater chance of sexual dissatisfaction only. Among men with LUTS, urgency with fear of leaking, urgency urinary incontinence, and nocturnal enuresis were associated with a greater chance of ED, whereas slow stream and urgency urinary incontinence were associated with a greater chance of sexual dissatisfaction.

CONCLUSION

These results demonstrate that the presence of LUTS is associated with an increased chance of ED and sexual dissatisfaction in Brazilian men and reinforce the importance of a comprehensive assessment of these conditions. Gomes CM, Averbeck MA, Koyama M, et al. Association Among Lower Urinary Tract Symptoms, Erectile Function, and Sexual Satisfaction: Results from the Brazil LUTS Study. Sex Med 2019;8:45-56.

The global prevalence of erectile dysfunction: a review

OBJECTIVE

To evaluate the global prevalence of erectile dysfunction (ED); as well as its association with physiological and pathological ageing by examining the relationship between ED and cardiovascular disease (CVD), benign prostatic hyperplasia (BPH), and dementia. We also aimed to characterise discrepancies caused by the use of different ED screening tools.

METHODS

The Excerpta Medica dataBASE (EMBASE) and Medical Literature Analysis and Retrieval System Online (MEDLINE) were searched to find population-based studies investigating the prevalence of ED and the association between ED and CVD, BPH, and dementia in the general population.

RESULTS

The global prevalence of ED was 3-76.5%. ED was associated with increasing age. Use of the International Index of Erectile Function (IIEF) and Massachusetts Male Aging Study (MMAS)-derived questionnaire identified a high prevalence of ED in young men. ED was positively associated with CVD. Men with ED have an increased risk of all-cause mortality odds ratio (OR) 1.26 (95% confidence interval [CI] 1.01-1.57), as well as CVD mortality OR 1.43 (95% CI 1.00-2.05). Men with ED are 1.33-6.24-times more likely to have BPH then men without ED, and 1.68-times more likely to develop dementia than men without ED.

CONCLUSION

ED screening tools in population-based studies are a major source of discrepancy. Non-validated questionnaires may be less sensitive than the IIEF and MMAS-derived questionnaire. ED constitutes a large burden on society given its high prevalence and impact on quality of life, and is also a risk factor for CVD, dementia, and all-cause mortality.

National Health and Wellness Survey exploratory cluster analysis of males 40-70 years old focused on erectile dysfunction and associated risk factors across the USA, Italy, Brazil and China

OBJECTIVES

Prior studies of erectile dysfunction (ED) tend to narrowly focus on relationships with specific comorbidities, rather than evaluating a more comprehensive array of risk factors and assessing naturalistic patterns among them. This study identifies natural clusters of male characteristics from a general population sample per country, quantifies ED dynamics in these profiles and compares profiles across the US, Italy, Brazil and China samples.

METHODS

National Health and Wellness Survey 2015 and 2016 patient-reported data on men aged 40-70 years (USA n = 15,652; Italy n = 2,521; Brazil n = 2,822; China n = 5,553) were analysed. Hierarchical agglomerative clustering identified clusters where predictors included demographics, health characteristics/behaviours, ED risk factors and provider visits in the past 6 months. Multinomial logistic regression assessed the independent utility of variables in predicting cluster membership, compared with the healthiest control cluster per country.

RESULTS

Different natural clusters were found across countries, with four clusters for the USA, Italy and China and three clusters for Brazil. Age, income, employment, health behaviours and ED risk factors predicted different cluster membership across countries. In the USA, Italy and Brazil, younger clusters were predicted by ED, unhealthy behaviours and ED risk factors. Unique cluster profiles were identified in China, with ED and ED risk factors (aside from hypertension) not predicting cluster membership, while socio-demographics and health behaviours were strongly predictive.

CONCLUSIONS

Natural cluster profiles revealed notable ED rates among adult males of age 40-70 in four different countries. Clusters were mainly predicted by unhealthy behaviours, ED risk factors and ED, regardless of level or presence of positive health characteristics and behaviours. This analysis identified meaningful subgroups of men with heightened ED risk factors, which can help healthcare providers to better recognise specific populations with the greatest need for intervention.

Prevalence of, and risk factors for erectile dysfunction in male type 2 diabetic outpatient attendees in Enugu, South East Nigeria

Context:

Erectile dysfunction (ED) is a strong predictor of poor quality of life in men with type 2 Diabetes mellitus (T2DM). Several studies evaluating ED in men with diabetes mellitus have been carried out, but few of these have been done in Nigeria. In Enugu, South East Nigeria, paucity of studies on this subject was observed.

Aims:

This study aims to determine the prevalence and predictors of ED in men with T2DM attending the diabetes clinics.

Settings and Design:

A descriptive cross-sectional study of men with T2DM in UNTH and Saint Mary's Hospital, Enugu, was carried out. The systematic sampling method was used to recruit participants.

Subjects and Methods:

Data collection from participants and their hospital records was done using semi-structured questionnaire. ED was assessed using the 5 items, international index of erectile function questionnaire.

Statistical Analysis Used:

Data analysis was done using SPSS version 20 and results presented as texts and tables. P value was set at <0.05.

Results:

A total of 325 participants with mean age of 57.8 ± 13.2 years were involved out of which 94.7% had ED. The proportion of participants with ED had increased with its severity. Predictors of ED included poor glycemic control, longer duration of diabetes, overweight/obesity, and older age. Poor ED health-seeking behavior and treatment were noted.

Conclusions:

The prevalence of ED is high. Lifestyle interventions targeted at improving glycemic control and weight loss may reduce the burden of this complication. We recommend objective ED screening using standard but brief instruments as part of routine evaluation of men with T2DM.

Self-reported sitting time and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: The Dogo Study

AIMS

No evidence exists regarding the association between sitting time and erectile dysfunction (ED) among patients with type 2 diabetes mellitus. The aim of this study was to evaluate the association between self-reported sitting time and ED among patients with type 2 diabetes mellitus.

METHODS

Study subjects were 430 male Japanese patients with type 2 diabetes mellitus (mean age, 60.5years). A self-administered questionnaire was used to collect information on the variables under study. The study subjects were asked about time spent sitting during typical 24-hour periods over the past 12months. Subjects were divided into four groups according to self-reported sitting time: 1) <5hours, 2) 5-7hours, 3) 7-9hours, and 4) ≥9hours. ED was defined as present when a subject had a Sexual Health Inventory for Men score <8. Adjustment was made for age, body mass index, duration of type 2 diabetes, current smoking, current drinking, hypertension, coronary artery disease, stroke, glycated hemoglobin, walking habit, and diabetic neuropathy.

RESULTS

The prevalence values of moderate to severe ED and severe ED were 36.1% and 49.8%. At least 9hours sitting was independently positively associated with severe ED but not moderate to severe ED; the adjusted OR was 1.84 (95% CI: 1.06-3.33). In the multivariate model, there was a statistically significant inverse exposure-response relationship between the self-reported sitting time and severe ED (p for trend=0.029).

CONCLUSIONS

Self-reported sitting time may be positively associated with ED in Japanese patients with type 2 diabetes mellitus.

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

Introduction

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

Aim

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

Methods

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

Main Outcome Measures

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

Results

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

Conclusion

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

Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports

Traditional factors that once explained men's sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography's unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.

The Circle of Lifestyle and Erectile Dysfunction

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.

How predictable is the erectile function of patients with epilepsy?

INTRODUCTION

Erectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties.

AIMS

This study aimed to identify independent predictor factors for ED in patients with epilepsy.

MAIN OUTCOME MEASURES

the five-question form of the International Index of Erectile Function (IIEF-5).

METHODS

Independent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis.

RESULTS

Eight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B=0.005; p=0.05), education levels in years (B=0.54; p=0.03), depressive symptoms determined by HADS depression subscale (B=-0.49; p=0.03), and prolactin levels (B=-0.45; p=0.07) showed a moderate association (r=0.64) with the IIEF questionnaire and explained 41% (r(2)=0.41) of its variation.

CONCLUSIONS

Erectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy.

Asexuality development among middle aged and older men

Objectives

To assess erectile function in middle-aged and older men with asexuality status and further analyze their specific reasons for this condition.

Subjects and Methods

Men who had regular sexual intercourse attempts (sex frequency≥1 time per month) were classified into mild erectile dysfunction (ED), moderate to severe ED and non-ED according to International Index of Erectile Function-5, and men having no sexual intercourse attempts for at least 6 months were defined as having an asexuality status. The risk factors associated with ED were collected in a sample of 1,531 Chinese men aged 40 to 80 years, and the self-report reasons for asexuality were recorded in asexual cohort individually. Comparative analyses and multivariate regression models were conducted among these groups.

Results

The prevalence rates of ED and asexuality status were 49.9% and 37.2%. The asexuality status group had higher risk factors than the moderate to severe ED group in terms of old age (age≥65, adjusted odds ratio (OR) 17.69 versus (Vs.) 7.19), diabetes (crude OR: 2.40 Vs. 2.36) and hypertension (crude OR: 1.78 Vs. 1.72). The specific reasons for the asexuality status were “erectile difficulty” (52.9%), “do not care about sexuality” (53.5%)”, “no longer necessary to have sexuality at this age” (47.7%), “severe stress” (44.4%), “severe fatigue” (26.3%) and “masturbation” (26.9%).

Conclusions

Men with an asexual status suffer from higher risk factors for ED than men with moderate to severe ED. The majority of this asexual status could be attributed to a full ED, although the reasons for this transient asexuality also involved sexual attitudes and interests, sexual partners and masturbation.

Insulin resistance is an independent determinate of ED in young adult men

Background

Insulin resistance (IR) triggers endothelial dysfunction, which contributes to erectile dysfunction (ED) and cardiovascular disease.

Aim

To evaluate whether IR was related to ED in young adult patients.

Methods

A total of 283 consecutive men complaining of ED at least six months were enrolled, with a full medical history, physical examination, and laboratory tests collected. Quantitative Insulin Sensitivity Check Index (QUICKI) was used to determine IR. The severity of ED was assessed by IIEF-5 questionnaire. Endothelial function was assessed by ultrasonographic examination of brachial artery flow mediated dilation (FMD).

Results

IR was detected in 52% patients. Subjects with IR had significant higher total cholesterol, triglycerides, low density lipoprotein-cholesterol (LDL-c), glycated haemoglobin (HBA1c), high sensitivity C-reactive protein (hs-CRP) and body mass index (BMI), but showed significant lower IIEF-5 score, FMD%, high density lipoprotein -cholesterol (HDL-c), testosterone, sex hormone binding globulin (SHBG) levels than patients without IR. Multiple regression analysis showed QUICKI and testosterone were independent predictors of IIEF-5 score. Furthermore, the incidence of IR was correlated with the severity of ED.

Conclusions

Compared with other CVFs, IR was found as the most prevalent in our subjects. Besides, IR was independently associated with ED and its severity, suggesting an adverse effect of insulin resistance on erectile function.

Organic causes of erectile dysfunction in men under 40

There are a significant number of men under 40 who experience erectile dysfunction (ED). In the past, the vast majority of cases were thought to be psychogenic in nature. Studies have identified organic etiologies in 15-72% of men with ED under 40. Organic etiologies include vascular, neurogenic, Peyronie's disease (PD), medication side effects and endocrinologic sources. Vascular causes are commonly due to focal arterial occlusive disease. Young men with multiple sclerosis, epilepsy and trauma in close proximity to the spinal cord are at increased risk of ED. It is estimated that 8% of men with PD are under 40, with 21% of these individuals experiencing ED. Medications causing ED include antidepressants, NSAIDs and finasteride (Propecia), antiepileptics and neuroleptics. Hormonal sources are uncommon in the young population, however possible etiologies include Klinefelter's syndrome, congenital hypogonadotropic hypogonadism, and acquired hypogonadotropic hypogonadism. The workup of young men with ED should include a thorough history and physical examination. The significant prevalence of vascular etiologies of ED in young men should prompt consideration of nocturnal penile tumescence testing and penile Doppler ultrasound. Treatment options that may improve ED include exercise and oral PDE-5 inhibitors.

One patient out of four with newly diagnosed erectile dysfunction is a young man--worrisome picture from the everyday clinical practice

INTRODUCTION

Erectile dysfunction (ED) is a common complaint in men over 40 years of age, and prevalence rates increase throughout the aging period. Prevalence and risk factors of ED among young men have been scantly analyzed.

AIM

Assessing sociodemographic and clinical characteristics of young men (defined as ≤ 40 years) seeking first medical help for new onset ED as their primary sexual disorder.

METHODS

Complete sociodemographic and clinical data from 439 consecutive patients were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF).

MAIN OUTCOME MEASURE

Descriptive statistics tested sociodemographic and clinical differences between ED patients ≤ 40 years and >40 years.

RESULTS

New onset ED as the primary disorder was found in 114 (26%) men ≤ 40 years (mean [standard deviation [SD]] age: 32.4 [6.0]; range: 17-40 years). Patients ≤ 40 years had a lower rate of comorbid conditions (CCI = 0 in 90.4% vs. 58.3%; χ(2) , 39.12; P < 0.001), a lower mean body mass index value (P = 0.005), and a higher mean circulating total testosterone level (P = 0.005) as compared with those >40 years. Younger ED patients more frequently showed habit of cigarette smoking and use of illicit drug, as compared with older men (all P ≤ 0.02). Premature ejaculation was more comorbid in younger men, whereas Peyronie's disease was prevalent in the older group (all P = 0.03). At IIEF, severe ED rates were found in 48.8% younger men and 40% older men, respectively (P > 0.05). Similarly, rates of mild, mild-to-moderate, and moderate ED were not significantly different between the two groups.

CONCLUSIONS

This exploratory analysis showed that one in four patients seeking first medical help for new onset ED was younger than 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients. Overall, younger men differed from older individuals in terms of both clinical and sociodemographic parameters.

La dysfonction érectile au Congo : premières données sur la fréquence de ce motif de consultation et profil clinique au centre hospitalier universitaire de Brazzaville

Objectif

Étudier les facteurs de risque et les résultats des investigations diagnostiques de la dysfonction érectile en consultation urologique à Brazzaville.

Méthodologie

Il s’agissait d’une étude prospective concernant 40 patients âgés de 20 à 80 ans vus en consultation externe d’urologie-andrologie du centre hospitalier et universitaire de Brazzaville pour dysfonction érectile, de décembre 2009 à août 2010. Les renseignements de la fiche d’enquête concernaient l’âge, les antécédents, les facteurs de risque, les caractéristiques cliniques et paracliniques, et l’Index international de la fonction érectile (IIEF-5) dans sa version française. Les logiciels Epi info version 3.5.1 et SPSS 11.5 ont permis l’enregistrement et l’analyse des données. Le test de Khi 2 a été utilisé pour la comparaison des variables quantitatives et le test d’analyse de variance (ANOVA) pour les variables qualitatives. Le seuil de significativité était de 0,05.

Résultats

La fréquence de la dysfonction érectile était de 14,7 %, avec une moyenne d’âge de 50,7 ± 12,3 ans (27–77 ans). La tranche d’âge de 40 à 50 ans était la plus touchée. La durée moyenne de l’ancienneté était de 2,6 ± 2,2 ans (trois mois à neuf ans). Les pathologies associées ont été l’HTA (22,5 %) et le diabète (15 %). Les facteurs de risque retrouvés ont été l’alcoolisme (75 %), le tabagisme (25 %) et l’obésité (12,5 %). La dysfonction érectile était sévère dans 47,5 % des cas et la sévérité était corrélée à l’âge. Elle était insupportable dans 40 % des cas.

Conclusion

La dysfonction érectile concerne 14,7 % des patients vus en consultation urologique. Ce chiffre est certainement sous-estimé en raison des tabous et de la pudeur.

Ethnic differences in dissatisfaction with sexual life in patients with type 2 diabetes in a Swedish town

Background

The first aim of this study was to analyze whether self-reported satisfaction with one's sexual life was associated with ethnicity (Swedish and Assyrian/Syrian) in patients with type 2 diabetes. The second was to study whether the association between satisfaction with one's sexual life and ethnicity remained after controlling for possible confounders such as marital status, HbA1c, medication, and presence of other diseases.

Methods

This cross-sectional, questionnaire-based study was conducted at four primary health care centers in the Swedish town of Södertälje. A total of 354 persons (173 ethnic Assyrians/Syrians and 181 ethnic Swedes) participated.

Results

The total prevalence of self-reported dissatisfaction with one's sexual life in both groups was 49%. No significant ethnic differences were found in the outcome. In the final model, regardless of ethnicity, the odds ratio (OR) for self-reported dissatisfaction with one's sexual life in those ≥ 70 years old was 2.52 (95% CI 1.33-4.80). Among those living alone or with children, the OR was more than three times higher than for married or cohabiting individuals (OR = 3.10, 95% CI 1.60-6.00). Those with other diseases had an OR 1.89 times (95% CI 1.10-3.40) higher than those without other diseases.

Conclusions

The findings demonstrate that almost half of participants were dissatisfied with their sexual life and highlight the importance of sexual life to people with type 2 diabetes. This factor should not be ignored in clinical evaluations. Moreover, the findings demonstrate that it is possible to include questions on sexual life in investigations of patients with type 2 diabetes and even in other health-related, questionnaire studies, despite the sensitivity of the issue of sexuality.