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Sparano C, Rastrelli G, Corona G, Vignozzi L, Vignoli D, Maggi M. Age disparity in couples and the sexual and general health of the male partner. Andrology 2024. [PMID: 39158122 DOI: 10.1111/andr.13738] [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: 06/14/2024] [Revised: 07/18/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Several robust epidemiological studies suggest that men are often engaged in sexual relationships with younger women with a variable, age-dependent age difference. However, the ageing process determines a significant worsening of the andrological status, which favors the onset of erectile dysfunction and hypogonadism. OBJECTIVES To analyze the effects of differences in age between the partners [delta (Δ) age (M - F)] on patients referring to the Andrology Unit of Careggi University Hospital for male sexual dysfunction. MATERIALS AND METHODS A monocentre cohort of 4055 male subjects was evaluated by SIEDY structured interview. The cross-sectional analysis assessed the psychobiological and relational correlates. The rate of forthcoming major cardiovascular events (MACE) was investigated in the longitudinal analysis. All the models have been adjusted for age, education, lifestyle, and chronic disease score. RESULTS ∆ age (M-F) shows a stepwise increase, according to the increasing age bands of the male partner. ∆ age (M-F) was associated with a greater number of children, at the cost of more conflictual relationships within the family. The phenotype of these relationships is characterized by the report of a partner with a higher sexual desire and a higher ability to reach climax. Men seeking a younger partner show more often a histrionic personality (p = 0.023) and higher testosterone levels (p = 0.032). However, having a younger partner doesn't improve the ability to obtain a full erection. Kaplan-Maier analysis of a longitudinal subgroup of patients followed longitudinally (N = 1402) for 4.3 ± 2,59 years, showed that patients in the fourth quartile had a higher rate of forthcoming MACE versus those in the first quartile (p = 0.005). DISCUSSION AND CONCLUSION In subjects with sexual dysfunctions (as in the general population) age-different relationships increase as a function of male ageing. A greater Δ age (M-F) is associated with specific men and relationship features and a higher risk of MACE.
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Affiliation(s)
- Clotilde Sparano
- Endocrinology Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Azienda AUSL, Maggiore Hospital, Bologna, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Daniele Vignoli
- Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Corona G, Santi D, Cocci A, Vena W, Pizzocaro A, Vignozzi L, Isidori AM, Pivonello R, Salonia A, Minhas S, Bettocchi C, Reisman Y, Maggi M. Long-term penile prosthesis couple's satisfaction: A systematic review and meta-analysis. Andrology 2024. [PMID: 39010798 DOI: 10.1111/andr.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/19/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
CONTEXT Data supporting successful and satisfactory penile prosthesis (PP) implantation outcomes are mainly based on subjective, rather than objective, analysis. OBJECTIVE To systematically review and objectively analyze, all available data related to patient and partner PP satisfaction. EVIDENCE ACQUISITION An extensive search was performed, including the following key-words: ("penile prosthesis" and "satisfaction"). The search, which accrued data from January 1, 1969, up to July 31, 2023, was restricted to English-language articles including human participants. EVIDENCE SYNTHESIS Out of 663 retrieved articles, 83 were considered including, 12,132 subjects with a mean age and mean follow-up of 58.6 [range 20; 77.1] years and 47.6 [range 6; 374] months, respectively. Overall, a high patient satisfaction rate was observed 83[80; 86]%. The satisfaction rate increased in subjects with three-piece PP and in those with a higher rate of cardiovascular or neurological diseases and was independent of the patient's age. Partner's satisfaction rate was lower when compared to that observed in men and it increased according to the use of inflatable devices and the presence of patient Peyronie's disease. The long-term complication rate was limited ranging from 3% for erosion to 4.6% when mechanical failure was considered. CONCLUSIONS Patient and partner satisfaction is excellent and increases with time. The number of complications is limited and is strongly associated with the presence of diabetes mellitus. PATIENT SUMMARY We found a high couple satisfaction score that was higher when reported by males compared to females. Patient satisfaction increased with time, and it was independent of age.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Azienda AUSL Bologna, Ospedale Maggiore, Bologna, Italy
| | - Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Florence, Italy
| | - Walter Vena
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Pizzocaro
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio "Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Unità di Andrologia e Medicina della Riproduzione, Sessualità e Affermazione di Genere, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Suks Minhas
- Department of Urology, Imperial College NHS Healthcare, London, UK
| | - Carlo Bettocchi
- Andrology and Male Genitalia Reconstructive Surgery Unit, University of Foggia, Foggia, Italy
| | - Yacov Reisman
- Sexual Medicine, Flare-Health, Amsterdam, the Netherlands
| | - Mario Maggi
- Endocrinology Unit, Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Mehta PS, Patra P, Tapasi S. Study of Association of Erectile Dysfunction in male subjects with the severity of Alcohol Dependence. Ind Psychiatry J 2024; 33:68-75. [PMID: 38853789 PMCID: PMC11155632 DOI: 10.4103/ipj.ipj_69_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 06/11/2024] Open
Abstract
Background Alcohol dependence syndrome is a major public health problem, and it impacts the social, psychological, medical, economic, and religious spheres of our existence. Persistent alcohol abuse impacts sexual functioning negatively and leads to the onset of sexual dysfunction. Aim This study was conducted to determine erectile dysfunction in males diagnosed with alcohol dependence syndrome and its association with the severity of alcohol dependence. Materials and Methods The descriptive, non-interventional, cross-sectional study was conducted at the Department of Psychiatry in a tertiary care hospital where 78 subjects diagnosed with alcohol dependence syndrome were assessed for severity of dependence with the Severity of Alcohol Dependence Questionnaire (SADQ-C). Erectile dysfunction in these subjects was assessed with the International Index of Erectile Function scale (IIEF) and the severity of the same was correlated with the severity of alcohol dependence. Results The results of our study indicated that erectile dysfunction was common in individuals having alcohol dependence syndrome and its severity was positively correlated with the severity of alcohol dependence. Unidentified sexual dysfunction may perpetuate alcohol dependence with poor response to deaddiction therapy. This information about sexual dysfunction due to alcohol dependence can also be used in motivational counseling of heavy drinkers to provide an impetus for change. Conclusions The prevalence of erectile dysfunction was significantly higher than that of the general population. The same was significantly elevated in patients with severe alcohol dependence as compared to those with mild/moderate alcohol dependence.
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Affiliation(s)
- Priyank Singh Mehta
- Department of Psychiatry, Centre of Excellence for Mental Health, Institute of Naval Medicine, INHS Asvini, Colaba, Mumbai, Maharashtra, India
| | - Priyadarshee Patra
- Department of Psychiatry, Centre of Excellence for Mental Health, Institute of Naval Medicine, INHS Asvini, Colaba, Mumbai, Maharashtra, India
| | - Santosh Tapasi
- Department of Psychiatry, Centre of Excellence for Mental Health, Institute of Naval Medicine, INHS Asvini, Colaba, Mumbai, Maharashtra, India
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Musa Obadia P, Pyana Kitenge J, Carsi Kuhangana T, Kalenga Ilunga G, Billen J, Kayembe-Kitenge T, Haufroid V, Mukalay wa Mukalay A, Ris L, Banza Lubaba Nkulu C, Nemery B, Enzlin P. Erectile dysfunction in copper and cobalt miners: a cross-sectional study in the former Katanga province, Democratic Republic of the Congo. Sex Med 2023; 11:qfad052. [PMID: 37869070 PMCID: PMC10588613 DOI: 10.1093/sexmed/qfad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Background The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt. Aim We aimed to investigate factors that are possibly associated with erectile dysfunction (ED) in metal miners in the former Katanga province of the Democratic Republic of the Congo. Methods In a cross-sectional study of 138 miners and 139 controls (bakers), we administered questionnaires to obtain sociodemographic and occupational data and to assess male sexual function (International Index of Erectile Function [IIEF]) and marital relation quality (Revised Dyadic Adjustment Scale). Furthermore, we measured trace metals in blood and urine, as well as testosterone and thyroid hormones in serum. Outcomes Outcomes included the prevalence of questionnaire-derived ED and the relation of ED with individual characteristics, serum testosterone, and environmental factors. Results Miners were on average 4 years older than bakers (mean ± SD, 37.5 ± 6.9 vs 33.3 ± 5.7 years). Miners had significantly lower scores than bakers on the IIEF (median [IQR], 66 [49-73] vs 73 [66-74]) and the 3 domains of the Revised Dyadic Adjustment Scale (consensus, satisfaction, cohesion). Free testosterone was significantly lower in miners than bakers (ng/dL; 8.11 [6.90-10.10] vs 10.52 [8.83-12.58]; P ˂ .001). In miners, sex hormone-binding globulin correlated positively with blood Pb and urinary Cd. In a multivariable analysis, mild to moderate ED or moderate ED (IIEF-erectile function score ≤18) was significantly associated with having a mining-related job (adjusted odds ratio [aOR], 2.6; 95% CI, 1.3-5.3), work seniority ˃5 years (aOR, 2.3; 95% CI, 1.1-4.6), alcohol consumption (aOR, 2.8; 95% CI, 1.2-6.7), and aphrodisiacs use (aOR, 4.2; 95% CI, 2.2-8.0). Mediation analysis showed that marital relationship partially mediated the relation between work seniority >5 years in mining and ED. Clinical Implications The high prevalence of ED found in artisanal mine workers indicates that work-related factors should be considered as possibly contributing, directly or indirectly, to sexual dysfunction in men. Strengths and Limitations Strengths include being the first epidemiologic study documenting ED with validated questionnaires and its possible determinants, including exposure to toxic metals, among young artisanal miners vs a suitable control group. Limitations are the cross-sectional design with convenience sampling and absence of objective confirmation of ED. Conclusion As compared with controls, miners reported poorer sexual function and lower quality of their marital relationship, and they had lower free testosterone levels, which may be due to their high exposure to trace metals.
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Affiliation(s)
- Paul Musa Obadia
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
| | - Joseph Pyana Kitenge
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
- Unité de Santé au travail et Santé environnementale, Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Trésor Carsi Kuhangana
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
- Ecole de Santé Publique, Université de Kolwezi, 07301 Kolwezi, Democratic Republic of the Congo
| | - Georges Kalenga Ilunga
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Jaak Billen
- Department of Laboratory Medicine, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Tony Kayembe-Kitenge
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
- Institut Supérieur des Techniques Médicales, 4748 Lubumbashi, Democratic Republic of the Congo
| | - Vincent Haufroid
- Toxicology and Applied Pharmacology, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Abdon Mukalay wa Mukalay
- Unité d’Epidémiologie clinique et Pathologies tropicales, Département de Santé Publique, Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Laurence Ris
- Département de Neurosciences, Faculté de Médecine, Université de Mons, 7000 Mons, Belgium
| | - Célestin Banza Lubaba Nkulu
- Unité de Toxicologie et Environnement, Ecole de Santé Publique, Université de Lubumbashi, 1825 Lubumbashi, Democratic Republic of the Congo
| | - Benoit Nemery
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, 3000 Leuven, Belgium
| | - Paul Enzlin
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
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Lapping-Carr L, Mustanski B, Ryan DT, Costales C, Newcomb ME. Stress and Depression Are Associated with Sexual Function and Satisfaction in Young Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2083-2096. [PMID: 37253920 PMCID: PMC10691266 DOI: 10.1007/s10508-023-02615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/27/2023] [Accepted: 04/30/2023] [Indexed: 06/01/2023]
Abstract
Prior research suggests that better mental health and higher relationship quality are associated with better sexual function and satisfaction. Such insights can inform intervention development for mental, relationship, and sexual health concerns. This study examined the interactions among these variables in a racially and ethnically diverse group of young men who have sex with men (YMSM) in serious relationships (N = 348). Data were drawn from wave 5 of a longitudinal cohort study. We examined cross-sectional associations between depression and stress (predictors) and sexual function, sexual satisfaction, and anal discomfort (outcomes) and to what extent these associations were moderated by relationship quality. Higher endorsement of depression and stress was associated with worse sexual functioning, lower sexual satisfaction, and more anal discomfort. We also found that fewer negative interactions, stronger commitment, and higher relationship satisfaction were associated with better sexual functioning and higher sexual satisfaction. Higher relationship satisfaction and commitment were found to attenuate the association between stress and sexual satisfaction. Contrary to expectations, higher relationship satisfaction also showed a trend toward exacerbating the association between depression and sexual functioning. These results suggest that, for YMSM, high relationship satisfaction and commitment may protect sexual satisfaction from being negatively impacted by high stress. However, YMSM in highly satisfying relationships may experience poor sexual functioning associated with depression as particularly distressing. This study addressed a major gap in the literature by focusing on mental, relationship, and sexual health in a diverse sample. Future research should examine a wider range of sexual functioning outcomes and include minority stress in study design.
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Affiliation(s)
- Leiszle Lapping-Carr
- Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St Clair St., Suite 1000, Chicago, IL, 60611, USA.
| | - Brian Mustanski
- Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St Clair St., Suite 1000, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel T Ryan
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cocoa Costales
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Ševčíková A, Gottfried J, Gocieková V, Gore-Gorszewska G, Blinka L, Kotík J. The Role of Non-penetrative Partnered Sex Activities in the Associations Among Erectile Difficulties, Sex and Relationship Satisfaction in Men Aged 50. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:30-40. [PMID: 38596765 PMCID: PMC10903707 DOI: 10.1080/19317611.2023.2169850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 04/11/2024]
Abstract
Objectives This study examined the associations among erectile difficulties, sexual satisfaction, and relationship satisfaction, and whether there is a buffering effect of non-penetrative partnered sex on relationship satisfaction in men aged 50+ who report erectile difficulties. Methods An analysis of survey data from 431 Czech men (aged 50-96, Mdn = 64). Results Engagement in non-penetrative partnered sex did not moderate the relationship between erectile difficulties and sexual and relationship satisfaction, but it was linked to higher sexual and relationship satisfaction. Conclusions The buffering effect of non-penetrative practices for the link between erectile difficulties and relationship satisfaction has not been supported.
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Affiliation(s)
- Anna Ševčíková
- Psychology Research Institute, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Jaroslav Gottfried
- Psychology Research Institute, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Veronika Gocieková
- Psychology Research Institute, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | | | - Lukas Blinka
- Psychology Research Institute, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Jan Kotík
- Psychology Research Institute, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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Tang D, Zhang Y, Zhang W, Li G, Geng H, Jiang H, Zhang X. Knowledge, Attitudes, and Practice Patterns Relating to Sexual Dysfunction Among Urologists and Andrologists in China. JAMA Netw Open 2023; 6:e2250177. [PMID: 36633849 PMCID: PMC9857643 DOI: 10.1001/jamanetworkopen.2022.50177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Although sexual function is an indispensable part of overall human health, both male and female sexual dysfunction have been poorly addressed in China. OBJECTIVE To explore the self-reported knowledge, attitudes, and practice patterns related to sexual dysfunction among urologists and andrologists in China. DESIGN, SETTING, AND PARTICIPANTS This survey study enrolled urologists and andrologists from various regions in China. Urologists and andrologists from 100 selected medical centers were invited to participate in the survey. Responses from eligible urologists and andrologists were analyzed from July 20 to 30, 2022. MAIN OUTCOMES AND MEASURES The primary outcomes were the respondents' basic characteristics and knowledge, attitudes, and practice patterns related to sexual dysfunction for both male and female patients. RESULTS Among 1687 urologists and andrologists (749 [98.7%] male; 375 participants [49.4%] aged 36-50 years) invited to participate, 759 were eligible, with 395 participants (52.0%) determined to have passing knowledge on diagnosis and treatment for male and female sexual dysfunction (defined as a score of 6 or more points) and 523 participants (68.9%) responding with positive attitudes, including interested in providing sex counseling and managing sexual issues for male and female patients. Moreover, of 395 individuals with passing knowledge, 289 participants (73.2%) were interested in providing sex counseling or sexual function care to patients; 336 participants (85.1%) thought they should routinely screen the spouse for sexual dysfunction when the partner was diagnosed with a sexual dysfunction. Among individuals with passing knowledge, 232 participants (58.7%) reported knowledge on the guidelines for diagnosis and treatment of premature ejaculation and 162 participants (41.0%) reported knowledge on the guidelines for the diagnosis and treatment of erectile dysfunction, which were significantly higher than rates among 364 participants with limited knowledge (premature ejaculation: 140 participants [38.5%]; erectile dysfunction: 78 participants [21.4%]). Only a few urologists and andrologists could manage female sexual dysfunction following guidelines, although the proportions were higher in the group with passing knowledge (38 participants [9.6%]) compared with those with less knowledge (5 participants [1.4%]). Additionally, most participants felt confident to manage male sexual issues (569 participants [75.0%] reporting often or almost always), while most of them were not so confident on female sexual issues (274 participants [36.1%] reporting often or almost always), mainly due to lacking knowledge in this field (518 participants [68.2%]). CONCLUSIONS AND RELEVANCE The findings of this survey study suggest that urologists and andrologists in China lacked knowledge on sexual dysfunction, which in turn was associated with their attitudes and clinical practice patterns, especially for female sexual dysfunction. More training on sexual dysfunction should be undertaken to improve this situation.
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Affiliation(s)
- Dongdong Tang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei City, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People’s Republic of China, Hefei City, China
| | - Yuyang Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei City, China
| | - Wei Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei City, China
| | - Guanjian Li
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei City, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People’s Republic of China, Hefei City, China
| | - Hao Geng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei City, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People’s Republic of China, Hefei City, China
| | - Hui Jiang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- Andrology Center, Peking University First Hospital, Beijing, China
| | - Xiansheng Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- Institute of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei City, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei City, China
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Abstract
Sexual function, and testosterone (T) levels, progressively decline in aging men. Associated morbidities and metabolic disorders can accelerate the phenomenon. The specific contribution of low T to sexual function impairment in aging men has still not been completely clarified. Similarly, the role of T replacement therapy (TRT), as well as the combination of TRT with phosphodiesterase type 5 inhibitors (PDE5i) for patients with erectile dysfunction (ED), is still conflicting. Here we aim to summarize and critically discuss all available data supporting the contribution of low T to sexual impairment observed with aging as well as the possible role of TRT. Available data on men with sexual dysfunction show that reduced sexual desire is the most important correlate of male hypogonadism. Conversely, aging and associated morbidities substantially attenuate the relationship between ED and T. TRT is effective in improving sexual function in middle-aged and older subjects but its role is small and extremely variable. Lifestyle interventions can result in similar outcomes to those of TRT. In conclusion, it is our opinion that PDE5i along with lifestyle measures should be considered the first approach for treating ED even in subjects with milder T deficiency. When these interventions fail or are difficult to apply, TRT should be considered.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Mario Serio, Italy.
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Ciaccio V, Di Giacomo D. Psychological Factors Related to Impotence as a Sexual Dysfunction in Young Men: A Literature Scan for Noteworthy Research Frameworks. Clin Pract 2022; 12:501-512. [PMID: 35892440 PMCID: PMC9326597 DOI: 10.3390/clinpract12040054] [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] [Received: 05/11/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the increasing interest in clinical practice in sexual dysfunction (SD) and the related relevance of psychological outcomes for young people, this area has been neglected in scientific scenarios. This study aims to draw on recent scientific findings and propose future research perspectives on the risk factors, diagnostic issues, and therapies that address SD for the under-40 age category, with particular attention paid to various psychological aspects. A literature search was conducted on studies published between March 2011 and March 2021. Anxiety, depression, and relational conflicts can both cause and affect sexual dysfunction. Psychological interventions have also proved to be important to organic causes; however, no review has found either sex education programs or multidisciplinary therapies. A multidisciplinary approach involving medical doctors and psychologists (trained in psychosexology) would improve not only the recognition of disorders through organic and psychogenic symptoms, but also treatment effectiveness.
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Affiliation(s)
- Valentina Ciaccio
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- Postgraduate School on Clinical Psychology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Dina Di Giacomo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- Postgraduate School on Clinical Psychology, University of L’Aquila, 67100 L’Aquila, Italy
- Laboratory of Clinical Psychology and Psychoncology of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Dewitte M, Bettocchi C, Carvalho J, Corona G, Flink I, Limoncin E, Pascoal P, Reisman Y, Van Lankveld J. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021; 9:100434. [PMID: 34626919 PMCID: PMC8766276 DOI: 10.1016/j.esxm.2021.100434] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far. AIM To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM). METHOD A comprehensive, narrative review of the literature was performed. MAIN OUTCOME MEASURES Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided. RESULTS A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable. CONCLUSION Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect. Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;9:100434.
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Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
| | - Carlo Bettocchi
- Policlinic, Urology Unit, University of Aldo Moro, Bari, Italy
| | - Joanna Carvalho
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Ida Flink
- Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Erika Limoncin
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Patricia Pascoal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal; Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal; Faculdade de Psicologia e Ciências da Educação & CPUP, Universidade do Porto, Portugal
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Cai Z, Li H. Developing a prediction model for the self-evaluation of erectile dysfunction in an adult male population. Andrologia 2020; 53:e13880. [PMID: 33108822 DOI: 10.1111/and.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Zhonglin Cai
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongjun Li
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Diniz AFA, Ferreira RC, de Souza ILL, da Silva BA. Ionic Channels as Potential Therapeutic Targets for Erectile Dysfunction: A Review. Front Pharmacol 2020; 11:1120. [PMID: 32848741 PMCID: PMC7396897 DOI: 10.3389/fphar.2020.01120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022] Open
Abstract
Erectile dysfunction (ED) is a prevalent condition, especially in men over 40 years old, characterized by the inability to obtain and/or maintain penile erection sufficient for satisfactory sexual intercourse. Several psychological and/or organic factors are involved in the etiopathogenesis of ED. In this context, we gathered evidence of the involvement of Large-conductance, Ca2+-activated K+ channels (BKCa), Small-conductance, Ca2+-activated K+ channels (SKCa), KCNQ-encoded voltage-dependent K+ channels (KV7), Transient Receptor Potential channels (TRP), and Calcium-activated Chloride channels (CaCC) dysfunctions on ED. In addition, the use of modulating agents of these channels are involved in relaxation of the cavernous smooth muscle cell and, consequent penile erection, suggesting that these channels are promising therapeutic targets for the treatment of erectile dysfunction.
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Affiliation(s)
- Anderson Fellyp Avelino Diniz
- Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Rafael Carlos Ferreira
- Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Iara Leão Luna de Souza
- Departamento de Ciências Biológicas e da Saúde, Universidade Estadual de Roraima, Boa Vista, Brazil
| | - Bagnólia Araújo da Silva
- Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, Universidade Federal da Paraíba, João Pessoa, Brazil
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Dhillon HS, Yadav B, Bhat PS, Dhillon GK, Sasidharan S. Association of sociodemographic factors with various domains of alcohol-induced sexual dysfunction - An Indian perspective. Ind Psychiatry J 2020; 29:272-278. [PMID: 34158712 PMCID: PMC8188919 DOI: 10.4103/ipj.ipj_112_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/30/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual dysfunction is frequently seen in alcohol-use disorders. The available research on this topic has studied erectile dysfunction and premature ejaculation using nonvalidated scales. This study was undertaken to study the other major domains of sexual dysfunction, namely sexual desire, orgasmic dysfunction and satisfaction, and their association with sociodemographic factors. MATERIALS AND METHODS A cross-sectional descriptive study design was used and 78 male patients were recruited. The assessment was conducted using a specially designed intake pro forma, International Index of Erectile Function (IIEF-15) Scale, DSM-5 and International Classification of Disease, 10th revision, diagnostic criteria for research. A correlation between the amount of alcohol consumed and its effect on various domains of sexual dysfunction was also carried out using Pearson's correlation coefficient. RESULTS The sociodemographic profile was studied in association with the overall (total) IIEF-15 subscale using analysis of variance (ANOVA). Statistically significant differences were observed among age groups, education subgroups, marital disharmony, years of alcohol use, and lifetime alcohol use. Further, since the values of ANOVA were significant, Tukey's post hoc analysis was carried out which showed a statistically significant difference among the groups. Various domains of sexual dysfunction showed a strongly negative correlation for overall IIEF subscale followed by intercourse satisfaction, sexual desire, and orgasmic function with years of alcohol use and lifetime alcohol use. CONCLUSION Sexual dysfunction in alcohol dependence patients was significantly associated with a family history of paternal alcohol abuse, lower educational background, increasing age, and marital disharmony. This study also found a strongly negative correlation between various domains of sexual functioning and years of alcohol use/lifetime alcohol use.
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Affiliation(s)
| | - Bhupendra Yadav
- Department of Psychiatry, 5 Air Force Hospital, Jorhat, Assam, India
| | - P S Bhat
- Brig Med, HQ 03 Corps, c/o 99 APO, Dimapur, Nagaland, India
| | | | - Shibu Sasidharan
- Department of Anaesthesiology and Critical Care, Level III Hospital, Goma, Congo
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Burgio G, Giammusso B, Calogero AE, Mollaioli D, Condorelli RA, Jannini EA, La Vignera S. Evaluation of the Mistakes in Self-Diagnosis of Sexual Dysfunctions in 11,000 Male Outpatients: A Real-Life Study in An Andrology Clinic. J Clin Med 2019; 8:jcm8101679. [PMID: 31615034 PMCID: PMC6832924 DOI: 10.3390/jcm8101679] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose: The aim of this study was to compare the initial request for sexual consultation with the final diagnosis and to evaluate the limits of the active andrological anamnesis concerning unclassified male sexual dysfunction. Methods: In this 12-year observational retrospective study, we collected data from patients referring to an andrological outpatient clinic, evaluating the requests, perceptions, needs, and self-diagnosis at their first visit and comparing them with the final diagnosis reached after a complete clinical, laboratory, and instrumental investigation. Results: A total of 11,200 patients were evaluated. The main request of andrological consultation was erectile dysfunction (ED) (52%), followed by premature ejaculation (PE) (28%), and low sexual desire (11.5%). Among the patients seeking help for ED, about 30% were ultimately found to have a different type of dysfunction and 24% were diagnosed with an “unmet need”, which included issues not present in the current nosography nonetheless affecting sexual and relational life. Among the patients referring for PE, the final diagnosis was lifelong PE for the large majority of them, regardless of whether initially they thought to have an acquired form. Several of those who sought consultation for acquired PE were frequently found to be able to compensate for lifelong PE by a subsequent coitus or were able to induce orgasm in the partner with different modalities. Among the patients referring for low sexual desire, only 57.5% were confirmed to have it; 23% had ED and 18.5% showed a raised threshold of penile sensitivity. Conclusions: The results of this study show that the reason for consultation is frequently misleading and raise the relevance of being aware of the so-called “unmet needs” and to discuss with the patient and the couple to explore the sexual history behind the self-diagnosis. These findings also suggest the need to expand the current taxonomy of male sexual dysfunctions.
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Affiliation(s)
- Giovanni Burgio
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
| | - Bruno Giammusso
- Urology Clinic, Policlinic "Morgagni", 95125 Catania, Italy.
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
| | - Daniele Mollaioli
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy.
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Which psychosocial variables affect drive the most? Analysis of sexual desire in a group of Italian men. Int J Impot Res 2019; 31:410-423. [DOI: 10.1038/s41443-018-0105-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
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Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Patients, partenaires et couple, dans la prise en charge de la dysfonction érectile. SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Démarche diagnostique et prise en charge du patient souffrant de dysfonction érectile, actualisation et consignes pratiques. SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Current epidemiology of erectile dysfunction, an update. SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol 2017; 6:79-90. [PMID: 28217453 PMCID: PMC5313296 DOI: 10.21037/tau.2016.09.06] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Epidemiological studies consistently show that prevalence of erectile dysfunction (ED) increases with ageing. Nonetheless, complaints of ED even in younger men are becoming more and more frequent. Healthcare professionals working in Sexual Medicine but even those operating in different clinical contexts might be adequately prepared to answer this increasing requirement. ED in younger men is likely to be overlooked and dismissed without performing any medical assessment, even the most basic ones, such as collection of medical history and physical exam. This is due to the widespread assumption that ED in younger individuals is a self-limiting condition, which does not deserve any clinical evaluation or therapy and can be managed only with patient reassurance. However, evidence shows that, in younger subjects, organic, psychological and relational conditions can contribute to the pathogenesis of ED and all these conditions might be evaluated and treated, whenever necessary. Among the organic conditions contributing to the onset of ED, metabolic and cardiovascular (CV) risk factors are surprisingly of particular relevance in this age group. In fact, in younger men with ED, even more than in older ones, recognizing CV risk factors or conditions suggestive of cardio-metabolic derangements can help identifying men who, although at low absolute risk due to young age, carry a high relative risk for development of CV events. In this view, the assessment of a possible organic component of ED even in younger individuals acquires a pivotal importance, because it offers the unique opportunity to unearth the presence of CV risk factors, thus allowing effective and high quality preventive interventions.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy;; I.N.B.B. - Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
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Corona G, Rastrelli G, Burri A, Jannini EA, Maggi M. The safety and efficacy of Avanafil, a new 2nd generation PDE5i: comprehensive review and meta-analysis. Expert Opin Drug Saf 2016; 15:237-47. [DOI: 10.1517/14740338.2016.1130126] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, Medical Department, Azienda-Usl Bologna, Bologna, Italy
| | - Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea Burri
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Emmanuele A. Jannini
- Endocrinology, Andrology and Medical Sexology, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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