Medicine › Psychiatry and Mental health

Sexual function and dysfunction studies

Works Count: 60928

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Description

This cluster of papers focuses on the epidemiology, risk factors, and management of sexual dysfunction, including erectile dysfunction, female sexual function, hypoactive sexual desire disorder, and the association with cardiovascular disease. It also explores the impact of menopause, psychological interventions, and endothelial function on sexual health. The Global Study of Sexual Attitudes and Behaviors is a prominent research focus.

Keywords

Sexual Dysfunction; Erectile Dysfunction; Female Sexual Function; Hypoactive Sexual Desire Disorder; Androgen Therapy; Cardiovascular Disease; Menopause; Psychological Interventions; Endothelial Function; Global Study

Distress about sex: a national survey of women in heterosexual relationships.

2003-01-01

John Bancroft , Jeni Loftus , J. Scott Long

ORIGINAL ARTICLES: Definitions/Epidemiology/Risk Factors for Sexual Dysfunction

2010-04-01

Ronald W. Lewis , Kerstin Fugl-Meyer , Giovanni Corona +5 more

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The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences

1999-07-01

Aytaç , Mckinlay , Krane

Objectives To project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health‐policy consequences using the … Objectives To project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health‐policy consequences using the recent developments in the UK as a case study. Methods Using the United Nations projected male population distributions by quinquennial age groups for 2025, the prevalence rates for ED were applied from the Massachusetts Male Aging Study (MMAS) to calculate the likely incidence of ED. The MMAS has the advantage of being the first study to provide population‐based rates rather than rates based on clinical samples. All the projections were age‐adjusted. Results It is estimated that in 1995 there were over 152 million men worldwide who experienced ED; the projections for 2025 show a prevalence of ≈322 million with ED, an increase of nearly 170 million men. The largest projected increases were in the developing world, i.e. Africa, Asia and South America. Discussion The likely worldwide increase in the prevalence of ED (associated with rapidly ageing populations) combined with newly available and highly publicized medical treatments, will raise challenging policy issues in nearly all countries. Already under‐funded national health systems will be confronted with unanticipated resource requests and challenges to existing government funding priorities. The projected trends represent a serious challenge for healthcare policy makers to develop and implement policies to prevent or alleviate ED.

Validation of the Female Sexual Distress Scale-Revised for Assessing Distress in Women with Hypoactive Sexual Desire Disorder

2007-12-04

Leonard R. Derogatis , Anita H. Clayton , Diane J. Lewis-D’Agostino +2 more

Quality of Life after Radical Prostatectomy or Watchful Waiting

2002-09-12

Gunnar Steineck , Fred Helgesen , Jan Adolfsson +4 more

We evaluated symptoms and self-assessments of quality of life in men with localized prostate cancer who participated in a randomized comparison between radical prostatectomy and watchful waiting.Between 1989 and 1999, … We evaluated symptoms and self-assessments of quality of life in men with localized prostate cancer who participated in a randomized comparison between radical prostatectomy and watchful waiting.Between 1989 and 1999, a group of Swedish urologists randomly assigned men with localized prostate cancer to radical prostatectomy or watchful waiting. In this follow-up study, we obtained information from 326 of 376 eligible men (87 percent) concerning certain symptoms, symptom-induced distress, well-being, and the subjective assessment of quality of life by means of a mailed questionnaire.Erectile dysfunction (80 percent vs. 45 percent) and urinary leakage (49 percent vs. 21 percent) were more common after radical prostatectomy, whereas urinary obstruction (e.g., 28 percent vs. 44 percent for weak urinary stream) was less common. Bowel function, the prevalence of anxiety, the prevalence of depression, well-being, and the subjective quality of life were similar in the two groups.The assignment of patients to watchful waiting or radical prostatectomy entails different risks of erectile dysfunction, urinary leakage, and urinary obstruction, but on average, the choice has little if any influence on well-being or the subjective quality of life after a mean follow-up of four years.

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Erectile Dysfunction and Coronary Risk Factors: Prospective Results from the Massachusetts Male Aging Study

2000-04-01

Henry A. Feldman , Catherine B. Johannes , Carol A. Derby +4 more

Diagnostic evaluation of the erectile function domain of the international index of erectile function

1999-08-01

Joseph C. Cappelleri , Raymond C. Rosen , Michael D. Smith +2 more

The DSFI: A multidimensional measure of sexual functioning

1979-09-01

Leonard R. Derogatis , Nick Melisaratos

Abstract The present report summarizes work to date on the Derogatis Sexual Functioning Inventory (DSFI), a multidimensional measure of human sexual functioning. We discuss the rationale for the test as … Abstract The present report summarizes work to date on the Derogatis Sexual Functioning Inventory (DSFI), a multidimensional measure of human sexual functioning. We discuss the rationale for the test as well as the selection of the primary domains of measurement. Reliability coefficients for the various subtests are given, and a review section on validation studies is provided, including a factor analysis, predictive validation, and discriminant function analyses. Prototypic clinical profiles are also provided for several of the major types of sexual dysfunction.

Nitric Oxide: A Physiologic Mediator of Penile Erection

1992-07-17

Arthur L. Burnett , Charles J. Lowenstein , David S. Bredt +2 more

Nitric oxide (NO) is a cytotoxic agent of macrophages, a messenger molecule of neurons, and a vasodilator produced by endothelial cells. NO synthase, the synthetic enzyme for NO, was localized … Nitric oxide (NO) is a cytotoxic agent of macrophages, a messenger molecule of neurons, and a vasodilator produced by endothelial cells. NO synthase, the synthetic enzyme for NO, was localized to rat penile neurons innervating the corpora cavernosa and to neuronal plexuses in the adventitial layer of penile arteries. Small doses of NO synthase inhibitors abolished electrophysiologically induced penile erections. These results establish NO as a physiologic mediator of erectile function.

Effects of SSRIs on Sexual Function

1999-02-01

Raymond C. Rosen , Roger Lane , Matthew Menza

Sexual problems are highly prevalent in both men and women and are affected by, among other factors, mood state, interpersonal functioning, and psychotropic medications.The incidence of antidepressant-induced sexual dysfunction is … Sexual problems are highly prevalent in both men and women and are affected by, among other factors, mood state, interpersonal functioning, and psychotropic medications.The incidence of antidepressant-induced sexual dysfunction is difficult to estimate because of the potentially confounding effects of the illness itself, social and interpersonal comorbidities, medication effects, and design and assessment problems in most studies. Estimates of sexual dysfunction vary from a small percentage to more than 80%. This article reviews current evidence regarding sexual side effects of selective serotonin reuptake inhibitors (SSRIs). Among the sexual side effects most commonly associated with SSRIs are delayed ejaculation and absent or delayed orgasm. Sexual desire (libido) and arousal difficulties are also frequently reported, although the specific association of these disorders to SSRI use has not been consistently shown. The effects of SSRIs on sexual functioning seem strongly dose-related and may vary among the group according to serotonin and dopamine reuptake mechanisms, induction of prolactin release, anticholinergic effects, inhibition of nitric oxide synthetase, and propensity for accumulation over time. A variety of strategies have been reported in the management of SSRI-induced sexual dysfunction, including waiting for tolerance to develop, dosage reduction, drug holidays, substitution of another antidepressant drug, and various augmentation strategies with 5-hydroxytryptamine-2 (5-HT2), 5-HT3, and [small alpha, Greek]2 adrenergic receptor antagonists, 5-HT1A and dopamine receptor agonists, and phosphodiesterase (PDE5) enzyme inhibitors. Sexual side effects of SSRIs should not be viewed as entirely negative; some studies have shown improved control of premature ejaculation in men. The impacts of sexual side effects of SSRIs on treatment compliance and on patients' quality of life are important clinical considerations. (J Clin Psychopharmacol 1999;19:67-85)

Impaired Neurogenic and Endothelium-Mediated Relaxation of Penile Smooth Muscle from Diabetic Men with Impotence

1989-04-20

I Sáenz de Tejada , Irwin Goldstein , Kazem M. Azadzoi +2 more

Relaxation of the smooth muscle of the corpora cavernosa of the penis is necessary for penile erection. To determine the relation of impaired relaxation to impotence in diabetic patients, we … Relaxation of the smooth muscle of the corpora cavernosa of the penis is necessary for penile erection. To determine the relation of impaired relaxation to impotence in diabetic patients, we performed an in vitro examination of corpus cavernosum tissue obtained at the time of implantation of a penile prosthesis in 21 diabetic and 42 nondiabetic men with impotence. Contraction was induced in isolated strips of corporal smooth muscle by norepinephrine; then relaxation was assessed with electrical stimulation of autonomic nerves and with the administration of three agents: acetylcholine, which is known to be mediated by endothelium-derived relaxing factor; papaverine; and sodium nitroprusside. The latter two act directly on smooth muscle (i.e., they are endothelium-independent). Autonomically mediated relaxation with electrical stimulation was less pronounced in the smooth muscle from diabetic men (n = 18) than in the smooth muscle from nondiabetic men (n = 24; P = 0.001). The degree of impairment increased with the duration of diabetes (r = 0.61, P = 0.007). Endothelium-dependent relaxation was also impaired, as evidenced by a lower degree of muscle relaxation after the administration of acetylcholine in the tissue from diabetic men (n = 16) than in that from nondiabetic men (n = 22; P = 0.001). The adverse effects of diabetes persisted after we controlled for smoking and hypertension. Endothelium-independent relaxation after the administration of nitroprusside and papaverine was similar in tissue from the diabetic and nondiabetic men. We conclude that diabetic men with impotence have impairment in both the autonomic and the endothelium-dependent mechanisms that mediate the relaxation of the smooth muscle of the corpora cavernosa. These findings may provide a rationale for the treatment of diabetic men with impotence by intracavernosal injection of vasodilators to induce endothelium-independent relaxation of the smooth muscle.

Causes of sexual dysfunction: the role of anxiety and cognitive interference.

1986-04-01

David H. Barlow

Sample Size Policy for Qualitative Studies Using In-Depth Interviews

2012-09-12

Shari L. Dworkin

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Organic Causes of Erectile Dysfunction in Men Under 40

2013-11-21

Wesley Ludwig , Michael Phillips

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 … 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.

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Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction

1999-12-01

RC Rosen , JC Cappelleri , MD Smith +2 more

Sexual satisfaction in long‐term heterosexual relationships: The interpersonal exchange model of sexual satisfaction

1995-12-01

Kelli-an Lawrance , E. Sandra Byers

Abstract This study examined the validity of the Interpersonal Exchange Model of Sexual Satisfaction (IEMSS) in long‐term, heterosexual sexual relationships. The IEMSS proposes that sexual satisfaction depends on one's levels … Abstract This study examined the validity of the Interpersonal Exchange Model of Sexual Satisfaction (IEMSS) in long‐term, heterosexual sexual relationships. The IEMSS proposes that sexual satisfaction depends on one's levels of rewards and costs in the sexual relationship, one's comparison levels (CL) for rewards/costs, and one's perceptions of the dyadic equality (EQ) of these rewards/costs. Sexual satisfaction is expected to be greater to the extent that, over time , levels of rewards (REW) exceed levels of costs (CST), relative reward levels (CLREW) exceed relative cost levels (CL cst ), and interpersonal equality of rewards (EQ rew ) and of costs (EQCST) is perceived to exist. Married/cohabiting community volunteers and university alumni/staff completed two questionnaires, 3 months apart. The results obtained from this well‐educated, relationally satisfied sample ( N = 143) provided excellent support for the IEMSS. Hierarchical regression analysis revealed that each component of the model (REW ‐ CST, CL rew ‐ CL cst , and EQ rew , EQ cst ) added to the prediction of sexual satisfaction as expected, accounting for 75% of the variance. Repeated measurement of the IEMSS components offered a better prediction of sexual satisfaction than a one‐time measure alone. Neither gender nor relationship satisfaction interacted with the IEMSS components. However, including relationship satisfaction (but not gender) in the model significantly improved the prediction of sexual satisfaction. It was concluded that the model should be revised to include relationship satisfaction. Both the exchange components of the IEMSS and sexual satisfaction uniquely predicted relationship satisfaction. The IEMSS offers a promising approach for understanding sexual satisfaction and its relationship to relationship satisfaction, as well as for reconciling inconsistent findings in the literature.

Sexual Function in Men Older Than 50 Years of Age: Results from the Health Professionals Follow-up Study

2003-08-05

Constance G. Bacon , Murray A. Mittleman , Ichiro Kawachi +3 more

Background: Although many studies have provided data on erectile dysfunction in specific settings, few studies have been large enough to precisely examine age-specific prevalence and correlates. Objective: To describe the … Background: Although many studies have provided data on erectile dysfunction in specific settings, few studies have been large enough to precisely examine age-specific prevalence and correlates. Objective: To describe the association between age and several aspects of sexual functioning in men older than 50 years of age. Design: Cross-sectional analysis of data from a prospective cohort study. Setting: U.S. health professionals. Participants: 31 742 men, age 53 to 90 years. Measurements: Questionnaires mailed in 2000 asked about sexual function, physical activity, body weight, smoking, marital status, medical conditions, and medications. Previous biennial questionnaires since 1986 asked about date of birth, alcohol intake, and other health information. Results: When men with prostate cancer were excluded, the age-standardized prevalence of erectile dysfunction in the previous 3 months was 33%. Many aspects of sexual function (including overall function, desire, orgasm, and overall ability) decreased sharply by decade after 50 years of age. Physical activity was associated with lower risk for erectile dysfunction (multivariable relative risk, 0.7 [95% CI, 0.6 to 0.7] for >32.6 metabolic equivalent hours of exercise per week vs. 0 to 2.7 metabolic equivalent hours of exercise per week), and obesity was associated with higher risk (relative risk, 1.3 [CI, 1.2 to 1.4] for body mass index >28.7 kg/m2 vs. <23.2 kg/m2). Smoking, alcohol consumption, and television viewing time were also associated with increased prevalence of erectile dysfunction. Men who had no chronic medical conditions and engaged in healthy behaviors had the lowest prevalence. Conclusions: Several modifiable health behaviors were associated with maintenance of good erectile function, even after comorbid conditions were considered. Lifestyle factors most strongly associated with erectile dysfunction were physical activity and leanness.

The International Index of Erectile Function (IIEF): a state-of-the-science review

2002-08-01

R. Rosen , Joseph C. Cappelleri , Noel Gendrano

The Female Sexual Distress Scale (FSDS): Initial Validation of a Standardized Scale for Assessment of Sexually Related Personal Distress in Women

2002-07-01

Leonard R. Derogatis , Raymond C. Rosen , Sandra R. Leiblum +2 more

Recent consensus-based characterizations of female sexual dysfunction have emphasized personal distress as an essential component of their definition. To assist researchers and clinicians, we developed a new scale, the Female … Recent consensus-based characterizations of female sexual dysfunction have emphasized personal distress as an essential component of their definition. To assist researchers and clinicians, we developed a new scale, the Female Sexual Distress Scale, to measure sexually related personal distress in women. In this article, we describe the initial stages in the development and validation of this instrument. Three studies involving a total of approximately 500 women were performed to evaluate the reliability and validity of the scale in different samples of sexually functional and dysfunctional women. Results indicated a unidimensional factor structure in both the original 20-item version and in a "polished" 12-item version. We observed a high degree of internal consistency and test-retest reliability in both versions across all three studies. Additionally, the scale showed a high degree of discriminative ability to distinguish between sexually dysfunctional and functional women in each of the studies. One study also showed a strong sensitivity to treatment response. Finally, we observed moderate positive correlations with other conceptually related nonsexual measures of distress, supporting the construct validity of the scale. Overall, these findings provide solid support for the FSDS as a valid and reliable measure for assessing sexually related personal distress in women.

Sexual Problems and Distress in United States Women

2008-11-01

Jan L. Shifren , Brigitta U. Monz , Patrícia A. Russo +2 more

In Brief OBJECTIVE: To estimate the prevalence of self-reported sexual problems (any, desire, arousal, and orgasm), the prevalence of problems accompanied by personal distress, and to describe related correlates. METHODS: … In Brief OBJECTIVE: To estimate the prevalence of self-reported sexual problems (any, desire, arousal, and orgasm), the prevalence of problems accompanied by personal distress, and to describe related correlates. METHODS: The 31,581 female respondents aged 18 years and older were from 50,002 households sampled from a national research panel representative of U.S. women. Correlates of each distressing sexual problem were evaluated using multiple logistic regression techniques. RESULTS: The age-adjusted point prevalence of any sexual problem was 43.1% and 22.2% for sexually related personal distress (defined as a score of at least 15 on Female Sexual Distress Scale). Any distressing sexual problem (defined as reporting both a sexual problem and sexually related personal distress, Female Sexual Distress Scale score of at least 15) occurred in 12.0% of respondents and was more common in women aged 45–64 years (14.8%) than in younger (10.8%) or older (8.9%) women. Correlates of distressing sexual problems included poor self-assessed health, low education level, depression, anxiety, thyroid conditions, and urinary incontinence. CONCLUSION: The prevalence of distressing sexual problems peaked in middle-aged women and was considerably lower than the prevalence of sexual problems. This underlines the importance of assessing the prevalence of sexually related personal distress in accurately estimating the prevalence of sexual problems that may require clinical intervention. LEVEL OF EVIDENCE: III Sexual problems are common in U.S. women and increase with age, but distressing sexual problems occur much less commonly and peak in middle-aged women.

Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men

2004-06-22

Katherine Esposito , Francesco Giugliano , Carmen Di Palo +5 more

Healthy lifestyle factors are associated with maintenance of erectile function in men.To determine the effect of weight loss and increased physical activity on erectile and endothelial functions in obese men.Randomized, … Healthy lifestyle factors are associated with maintenance of erectile function in men.To determine the effect of weight loss and increased physical activity on erectile and endothelial functions in obese men.Randomized, single-blind trial of 110 obese men (body mass index > or =30) aged 35 to 55 years, without diabetes, hypertension, or hyperlipidemia, who had erectile dysfunction that was determined by having a score of 21 or less on the International Index of Erectile Function (IIEF). The study was conducted from October 2000 to October 2003 at a university hospital in Italy.The 55 men randomly assigned to the intervention group received detailed advice about how to achieve a loss of 10% or more in their total body weight by reducing caloric intake and increasing their level of physical activity. Men in the control group (n = 55) were given general information about healthy food choices and exercise.Erectile function score, levels of cholesterol and triglycerides, circulating levels of interleukin 6, interleukin 8, and C-reactive protein, and endothelial function as assessed by vascular responses to l-arginine.After 2 years, body mass index decreased more in the intervention group (from a mean [SD] of 36.9 [2.5] to 31.2 [2.1]) than in the control group (from 36.4 [2.3] to 35.7 [2.5]) (P<.001), as did serum concentrations of interleukin 6 (P =.03), and C-reactive protein (P =.02). The mean (SD) level of physical activity increased more in the intervention group (from 48 [10] to 195 [36] min/wk; P<.001) than in the control group (from 51 [9] to 84 [28] min/wk; P<.001). The mean (SD) IIEF score improved in the intervention group (from 13.9 [4.0] to 17 [5]; P<.001), but remained stable in the control group (from 13.5 [4.0] to 13.6 [4.1]; P =.89). Seventeen men in the intervention group and 3 in the control group (P =.001) reported an IIEF score of 22 or higher. In multivariate analyses, changes in body mass index (P =.02), physical activity (P =.02), and C-reactive protein (P =.03) were independently associated with changes in IIEF score.Lifestyle changes are associated with improvement in sexual function in about one third of obese men with erectile dysfunction at baseline.

Prevalence and Risk Factors for Erectile Dysfunction in the US

2007-02-01

Elizabeth Selvin , Arthur L. Burnett , Elizabeth A. Platz

Nitric Oxide as a Mediator of Relaxation of the Corpus Cavernosum in Response to Nonadrenergic, Noncholinergic Neurotransmission

1992-01-09

Jacob Rajfer , William J. Aronson , Margaret A. Bush +2 more

Nitric oxide has been identified as an endothelium-derived relaxing factor in blood vessels. We tried to determine whether it is involved in the relaxation of the corpus cavernosum that allows … Nitric oxide has been identified as an endothelium-derived relaxing factor in blood vessels. We tried to determine whether it is involved in the relaxation of the corpus cavernosum that allows penile erection. The relaxation of this smooth muscle is known to occur in response to stimulation by nonadrenergic, noncholinergic neurons.We studied strips of corpus cavernosum tissue obtained from 21 men in whom penile prostheses were inserted because of impotence. The mounted smooth-muscle specimens were pretreated with guanethidine and atropine and submaximally contracted with phenylephrine. We then studied the smooth-muscle relaxant responses to stimulation by an electrical field and to nitric oxide.Electrical-field stimulation caused a marked, transient, frequency-dependent relaxation of the corpus cavernosum that was inhibited in the presence of N-nitro-L-arginine and N-amino-L-arginine, which selectively inhibit the biosynthesis of nitric oxide from L-arginine. The addition of excess L-arginine, but not D-arginine, largely reversed these inhibitory effects. The specific liberation of nitric oxide (by S-nitroso-N-acetylpenicillamine) caused rapid, complete, and concentration-dependent relaxation of the corpus cavernosum. The relaxation caused by either electrical stimulation or nitric oxide was enhanced by a selective inhibitor of cyclic guanosine monophosphate (GMP) phosphodiesterase (M&B 22,948). Relaxation was inhibited by methylene blue, which inhibits cyclic GMP synthesis.Our findings support the hypothesis that nitric oxide is involved in the nonadrenergic, noncholinergic neurotransmission that leads to the smooth-muscle relaxation in the corpus cavernosum that permits penile erection. Defects in this pathway may cause some forms of impotence.

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Frequency of Sexual Dysfunction in “Normal” Couples

1978-07-20

Ellen Frank , Carol Anderson , Debra Rubinstein

In analyzing the responses of 100 predominantly white, well educated and happily married couples to a self-report questionnaire, this study examined the frequency of sexual problems experienced and the relations … In analyzing the responses of 100 predominantly white, well educated and happily married couples to a self-report questionnaire, this study examined the frequency of sexual problems experienced and the relations of those problems to sexual satisfaction. Although over 80 per cent of the couples reported that their marital and sexual relations were happy and satisfying, 40 per cent of the men reported erectile or ejaculatory dysfunction, and 63 per cent of the women reported arousal or orgasmic dysfunction. In addition, 50 per cent of the men and 77 per cent of the women reported difficulty that was not dysfunctional in nature (e.g., lack of interest or inability to relax). The number of "difficulties" reported was more strongly and consistently related to overall sexual dissatisfaction than the number of "dysfunctions."

The Female Sexual Response: A Different Model

2000-01-01

Rosemary Basson

Abstract Clarification of women's sexual response during long-term relationships is needed. I have presented a model that more accurately depicts the responsive component of women's desire and the underlying motivational … Abstract Clarification of women's sexual response during long-term relationships is needed. I have presented a model that more accurately depicts the responsive component of women's desire and the underlying motivational forces that trigger it. The variety of arousal/ orgasm responses is also acknowledged. The purpose is both to prevent diagnosing dysfunction when the response is simply different from the traditional humansex-response cycle and to more clearly define subgroups ofdysfunction.Thelatter wouldappear tobe necessary before progress in newer treatment modalities, including pharmacological, can be made.

Sexual Dysfunction in the United States

1999-02-10

Edward O. Laumann , Anthony Paik , Raymond C. Rosen

Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and … Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men.Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders.Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults.Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome MeasuresRisk of experiencing sexual dysfunction as well as negative concomitant outcomes. ResultsSexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment.Women of different racial groups demonstrate different patterns of sexual dysfunction.Differences among men are not as marked but generally consistent with women.Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health.Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. ConclusionsThe results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.

REPORT OF THE INTERNATIONAL CONSENSUS DEVELOPMENT CONFERENCE ON FEMALE SEXUAL DYSFUNCTION: DEFINITIONS AND CLASSIFICATIONS

2000-03-01

Rosemary Basson , Jennifer R. Berman , Arthur L. Burnett +7 more

Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction.An interdisciplinary consensus conference panel consisting of … Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction.An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders.Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified.We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.

Epidemiology/Risk Factors of Sexual Dysfunction

2004-07-01

Ronald W. Lewis , Kersten S. Fugl-Meyer , Ramón Bosch +4 more

Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’

2000-12-01

M. Braun , Gernot Wassmer , T. Klotz +3 more

The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction

1997-06-01

Raymond C. Rosen , Alan Riley , Gorm Wagner +3 more

Summary of the Recommendations on Sexual Dysfunctions in Men

2010-10-29

Francesco Montorsi , Ganesan Adaikan , Edgardo Becher +7 more

A Study of Sexuality and Health among Older Adults in the United States

2007-08-22

Stacy Tessler Lindau , L. Philip Schumm , Edward O. Laumann +3 more

Despite the aging of the population, little is known about the sexual behaviors and sexual function of older people. Despite the aging of the population, little is known about the sexual behaviors and sexual function of older people.

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Erectile Dysfunction and Subsequent Cardiovascular Disease

2005-12-20

Ian M. Thompson , Catherine M. Tangen , Phyllis J. Goodman +3 more

The risk factors for cardiovascular disease and erectile dysfunction are similar.To examine the association of erectile dysfunction and subsequent cardiovascular disease.Men aged 55 years or older who were randomized to … The risk factors for cardiovascular disease and erectile dysfunction are similar.To examine the association of erectile dysfunction and subsequent cardiovascular disease.Men aged 55 years or older who were randomized to the placebo group (n = 9457) in the Prostate Cancer Prevention Trial at 221 US centers were evaluated every 3 months for cardiovascular disease and erectile dysfunction between 1994 and 2003. Proportional hazards regression models were used to evaluate the association of erectile dysfunction and cardiovascular disease. In an adjusted model, covariates included age, body mass index, blood pressure, serum lipids, diabetes, family history of myocardial infarction, race, smoking history, physical activity, and quality of life.Erectile dysfunction and cardiovascular disease.Of the 9457 men randomized to placebo, 8063 (85%) had no cardiovascular disease at study entry; of these men, 3816 (47%) had erectile dysfunction at study entry. Among the 4247 men without erectile dysfunction at study entry, 2420 men (57%) reported incident erectile dysfunction after 5 years. After adjustment, incident erectile dysfunction was associated with a hazard ratio of 1.25 (95% confidence interval [CI], 1.02-1.53; P = .04) for subsequent cardiovascular events during study follow-up. For men with either incident or prevalent erectile dysfunction, the hazard ratio was 1.45 (95% CI, 1.25-1.69; P<.001). For subsequent cardiovascular events, the unadjusted risk of an incident cardiovascular event was 0.015 per person-year among men without erectile dysfunction at study entry and was 0.024 per person-year for men with erectile dysfunction at study entry. This association was in the range of risk associated with current smoking or a family history of myocardial infarction.Erectile dysfunction is a harbinger of cardiovascular clinical events in some men. Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors.

The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function

2000-04-01

R. Rosen , Candace Brown , Julia R. Heiman +5 more

Abstract This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by … Abstract This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6- domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r=0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach’s alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p<0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric(as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.

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The Female Sexual Function Index (FSFI): Cross-Validation and Development of Clinical Cutoff Scores

2005-01-01

Markus Wiegel , Cindy M. Meston , Raymond C. Rosen

The Female Sexual Function Index (FSFI) is a brief, multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, … The Female Sexual Function Index (FSFI) is a brief, multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003 Meston, C. M. 2003. Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. Journal of Sex & Marital Therapy, 29: 39–46. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]; Rosen et al., 2000 Rosen, R. C., Brown, C., Heiman, J., Leiblum, S., Meston, C. M., Shabsigh, R., Ferguson, D. and D'Agostino, R. 2000. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26: 191–208. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). The present study was designed to cross-validate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics–curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's > 0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off, we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.

Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation

2010-02-21

Konstantinos Hatzimouratidis , Edouard Amar , Ian Eardley +5 more

INCIDENCE OF ERECTILE DYSFUNCTION IN MEN 40 TO 69 YEARS OLD: LONGITUDINAL RESULTS FROM THE MASSACHUSETTS MALE AGING STUDY

2000-02-01

Catherine B. Johannes , Andre B. Araujo , Henry A. Feldman +3 more

We estimated the incidence of erectile dysfunction in men 40 to 69 years old at study entry during an average 8.8-year followup, and determined how risk varied with age, socioeconomic … We estimated the incidence of erectile dysfunction in men 40 to 69 years old at study entry during an average 8.8-year followup, and determined how risk varied with age, socioeconomic status and medical conditions.Data from a randomly sampled population based longitudinal study of Massachusetts men were analyzed. A total of 1,709 men completed the baseline interview during 1987 to 1989 and 1,156 survivors completed followup from 1995 to 1997. The analysis sample consisted of 847 men without erectile dysfunction at baseline and with complete followup information. Erectile dysfunction was assessed by discriminant analysis of 13 questions from a self-administered sexual function questionnaire and a single global self-rating question.The crude incidence rate for erectile dysfunction was 25.9 cases per 1,000 man-years (95% confidence interval [CI] 22.5 to 29.9). The annual incidence rate increased with each decade of age and was 12.4 cases per 1,000 man-years (95% CI 9.0 to 16.9), 29.8 (24.0 to 37.0) and 46.4 (36.9 to 58.4) for men 40 to 49, 50 to 59 and 60 to 69 years old, respectively. The age adjusted risk of erectile dysfunction was higher for men with lower education, diabetes, heart disease and hypertension. Population projections for men 40 to 69 years old suggest that 17,781 new cases of erectile dysfunction in Massachusetts and 617,715 in the United States (white males only) are expected annually.Although prevalence estimates and cross-sectional correlates of erectile dysfunction have recently been established, incidence estimates were lacking. Incidence is necessary to assess risk, and plan treatment and prevention strategies. The risk of erectile dysfunction was about 26 cases per 1,000 men annually, and increased with age, lower education, diabetes, heart disease and hypertension.

Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors

2004-06-24

Edward O. Laumann , A. Nicolosi , Dale B. Glasser +4 more

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The Arizona Sexual Experience Scale (ASEX): Reliability and Validity

2000-01-01

Cynthia A. McGahuey , Alan J. Gelenberg , Cindi Laukes +4 more

Although sexual dysfunction is common in psychiatric patients, quantification of sexual dysfunction is limited by the paucity of validated,user-friendly scales. Inorder to address this problem,the authors have developed the Arizona … Although sexual dysfunction is common in psychiatric patients, quantification of sexual dysfunction is limited by the paucity of validated,user-friendly scales. Inorder to address this problem,the authors have developed the Arizona Sexual Experiences Scale (ASEX), a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. Possible total scores range from 5 to 30, with the higher scores indicating more sexual dysfunction. This study assesses the internal consistency, test-retest reliability, and convergent and discriminant validity of the ASEX.

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Physiology of penile erection

1995-01-01

K E Andersson , G.F. Wagner

Oral Sildenafil in the Treatment of Erectile Dysfunction

1998-05-14

Irwin Goldstein , Tom F. Lue , Harin Padma-Nathan +3 more

Sildenafil is a potent inhibitor of cyclic guanosine monophosphate in the corpus cavernosum and therefore increases the penile response to sexual stimulation. We evaluated the efficacy and safety of sildenafil, … Sildenafil is a potent inhibitor of cyclic guanosine monophosphate in the corpus cavernosum and therefore increases the penile response to sexual stimulation. We evaluated the efficacy and safety of sildenafil, administered as needed in two sequential double-blind studies of men with erectile dysfunction of organic, psychogenic, or mixed causes.

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Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study

1994-01-01

Henry A. Feldman , Irwin Goldstein , Dimitrios Hatzichristou +2 more

No AccessJournal of Urology1 Jan 1994Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study Henry A. Feldman, Irwin Goldstein, Dimitrios G. Hatzichristou, Robert J. Krane, … No AccessJournal of Urology1 Jan 1994Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study Henry A. Feldman, Irwin Goldstein, Dimitrios G. Hatzichristou, Robert J. Krane, and John B. McKinlay Henry A. FeldmanHenry A. Feldman More articles by this author , Irwin GoldsteinIrwin Goldstein More articles by this author , Dimitrios G. HatzichristouDimitrios G. Hatzichristou More articles by this author , Robert J. KraneRobert J. Krane More articles by this author , and John B. McKinlayJohn B. McKinlay More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)34871-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail We provide current, normative data on the prevalence of impotence, and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study. The Massachusetts Male Aging Study was a community based, random sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject’s home. A self-administered sexual activity questionnaire was used to characterize erectile potency. The combined prevalence of minimal, moderate and complete impotence was 52%. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. Subject age was the variable most strongly associated with impotence. After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension. We conclude that impotence is a major health concern in light of the high prevalence, is strongly associated with age, has multiple determinants, including some risk factors for vascular disease, and may be due partly to modifiable para-aging phenomena. © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChen T, Li S and Eisenberg M (2022) Associations between Race and Erectile Dysfunction Treatment PatternsUrology Practice, VOL. 9, NO. 5, (423-430), Online publication date: 1-Sep-2022.Calzo J, Austin S, Charlton B, Missmer S, Kathrins M, Gaskins A and Chavarro J (2020) Erectile Dysfunction in a Sample of Sexually Active Young Adult Men from a U.S. Cohort: Demographic, Metabolic and Mental Health CorrelatesJournal of Urology, VOL. 205, NO. 2, (539-544), Online publication date: 1-Feb-2021.Lauterbach R, Gruenwald I, Linder R, Matanes E, Gutzeit O, Aharoni S, Mick I, Weiner Z, Fainaru O and Lowenstein L (2021) In Vitro Fertilization Entails a High Prevalence of Erectile and Male Sexual Dysfunction: A Prospective Case-Control StudyJournal of Urology, VOL. 206, NO. 4, (994-1000), Online publication date: 1-Oct-2021.Assaly-Kaddoum R, Giuliano F, Laurin M, Gorny D, Kergoat M, Bernabé J, Vardi Y, Alexandre L and Behr-Roussel D (2016) Low Intensity Extracorporeal Shock Wave Therapy Improves Erectile Function in a Model of Type II Diabetes Independently of NO/cGMP PathwayJournal of Urology, VOL. 196, NO. 3, (950-956), Online publication date: 1-Sep-2016.Peyton C, Colaco M, Kovell R, Kim J and Terlecki R (2015) Erectile Dysfunction is Predictive of Endothelial Dysfunction in a Well Visit PopulationJournal of Urology, VOL. 195, NO. 4 Part 1, (1045-1050), Online publication date: 1-Apr-2016.Pham K, Johnston R, Jeldres C, Lewinshtein D and Porter C (2014) The Impact of Multiple Prostate Needle Biopsies on Long-Term Erectile DysfunctionUrology Practice, VOL. 2, NO. 2, (85-89), Online publication date: 1-Mar-2015.Pu X, Wen A, Liu J, Zheng X, Xiao H, Xu Z, Wang H, Li D and Zhang R (2014) shRNA Constructs Targeting IGFBP-3 Alleviate Age Related Erectile Dysfunction in the RatJournal of Urology, VOL. 192, NO. 3, (990-996), Online publication date: 1-Sep-2014.Wang T, Li M, Yuan H, Zhan Y, Xu H, Wang S, Yang W, Liu J, Ye Z and Li L (2013) saRNA Guided iNOS Up-Regulation Improves Erectile Function of Diabetic RatsJournal of Urology, VOL. 190, NO. 2, (790-798), Online publication date: 1-Aug-2013.Ryu J, Jin H, Yin G, Kwon M, Song K, Choi M, Park J, Das N, Kwon K, Batbold D, Lee T, Gao Z, Kim K, Kim W and Suh J (2013) Erectile Dysfunction Precedes Other Systemic Vascular Diseases Due to Incompetent Cavernous Endothelial Cell-Cell JunctionsJournal of Urology, VOL. 190, NO. 2, (779-789), Online publication date: 1-Aug-2013.Munarriz R, Uberoi J, Fantini G, Martinez D and Lee C (2009) Microvascular Arterial Bypass Surgery: Long-Term Outcomes Using Validated InstrumentsJournal of Urology, VOL. 182, NO. 2, (643-648), Online publication date: 1-Aug-2009.Marien T, Sankin A and Lepor H (2009) Factors Predicting Preservation of Erectile Function in Men Undergoing Open Radical Retropubic ProstatectomyJournal of Urology, VOL. 181, NO. 4, (1817-1822), Online publication date: 1-Apr-2009.Bivalacqua T, Sussan T, Gebska M, Strong T, Berkowitz D, Biswal S, Burnett A and Champion H (2008) Sildenafil Inhibits Superoxide Formation and Prevents Endothelial Dysfunction in a Mouse Model of Secondhand Smoke Induced Erectile DysfunctionJournal of Urology, VOL. 181, NO. 2, (899-906), Online publication date: 1-Feb-2009.Pavone C, Curto F, Anello G, Serretta V, Almasio P and Pavone-Macaluso M (2018) Prospective, Randomized, Crossover Comparison of Sublingual Apomorphine (3 mg) With Oral Sildenafil (50 mg) for Male Erectile DysfunctionJournal of Urology, VOL. 179, NO. 5S, (S92-S94), Online publication date: 1-May-2008.Safarinejad M and Hosseini S (2008) Salvage of Sildenafil Failures With Bremelanotide: A Randomized, Double-Blind, Placebo Controlled StudyJournal of Urology, VOL. 179, NO. 3, (1066-1071), Online publication date: 1-Mar-2008.Loughlin K (2008) The Current Status of Medical Student Urological Education in the United StatesJournal of Urology, VOL. 179, NO. 3, (1087-1091), Online publication date: 1-Mar-2008.Carson C (2007) Vascular Risk Factors for Erectile DysfunctionJournal of Urology, VOL. 178, NO. 6, (2250-2251), Online publication date: 1-Dec-2007.Kendirci M, Trost L, Sikka S and Hellstrom W (2007) The Effect of Vascular Risk Factors on Penile Vascular Status in Men With Erectile DysfunctionJournal of Urology, VOL. 178, NO. 6, (2516-2520), Online publication date: 1-Dec-2007.Koulikov D, Fridmans A, Chertin B, Shenfeld O, Farkas A and Spitz I (2018) Is Sildenafil Citrate Associated With an Amelioration of the Symptomatology of Androgen Decline in the Aging Male?Journal of Urology, VOL. 177, NO. 6, (2267-2271), Online publication date: 1-Jun-2007.Burke J, Jacobson D, McGree M, Nehra A, Roberts R, Girman C, Lieber M and Jacobsen S (2018) Diabetes and Sexual Dysfunction: Results From the Olmsted County Study of Urinary Symptoms and Health Status Among MenJournal of Urology, VOL. 177, NO. 4, (1438-1442), Online publication date: 1-Apr-2007.McVary K, Monnig W, Camps J, Young J, Tseng L and van den Ende G (2018) Sildenafil Citrate Improves Erectile Function and Urinary Symptoms in Men With Erectile Dysfunction and Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Randomized, Double-Blind TrialJournal of Urology, VOL. 177, NO. 3, (1071-1077), Online publication date: 1-Mar-2007.Morano S, Gatti A, Mandosi E, Tiberti C, Fallarino M, Cipriani R, Buchetti B, Gandini L, Sgrò P, Jannini E, Lenti L and Lenzi A (2018) Circulating Monocyte Oxidative Activity is Increased in Patients With Type 2 Diabetes and Erectile DysfunctionJournal of Urology, VOL. 177, NO. 2, (655-659), Online publication date: 1-Feb-2007.Shiri R, Koskimäki J, Tammela T, Häkkinen J, Auvinen A and Hakama M (2018) Bidirectional Relationship Between Depression and Erectile DysfunctionJournal of Urology, VOL. 177, NO. 2, (669-673), Online publication date: 1-Feb-2007.Travison T, Shabsigh R, Araujo A, Kupelian V, O’Donnell A and McKinlay J (2018) The Natural Progression and Remission of Erectile Dysfunction: Results From the Massachusetts Male Aging StudyJournal of Urology, VOL. 177, NO. 1, (241-246), Online publication date: 1-Jan-2007.De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, Kaplan S, Rossi M, Sacco M, Tognoni G, Valentini M and Nicolucci A (2018) Clinical and Psychological Predictors of Incidence of Self-Reported Erectile Dysfunction in Patients With Type 2 DiabetesJournal of Urology, VOL. 177, NO. 1, (252-257), Online publication date: 1-Jan-2007.Greco C, Soontrapornchai K, Wirojanan J, Gould J, Hagerman P and Hagerman R (2018) Testicular and Pituitary Inclusion Formation in Fragile X Associated Tremor/Ataxia SyndromeJournal of Urology, VOL. 177, NO. 4, (1434-1437), Online publication date: 1-Apr-2007.El-Sakka A and Hassoba H (2018) Age Related Testosterone Depletion in Patients With Erectile DysfunctionJournal of Urology, VOL. 176, NO. 6, (2589-2593), Online publication date: 1-Dec-2006.Riedner C, Rhoden E, Ribeiro E and Fuchs S (2018) Central Obesity is an Independent Predictor of Erectile Dysfunction in Older MenJournal of Urology, VOL. 176, NO. 4, (1519-1523), Online publication date: 1-Oct-2006.Sun P, Cameron A, Seftel A, Shabsigh R, Niederberger C and Guay A (2018) Erectile Dysfunction—An Observable Marker of Diabetes Mellitus? A Large National Epidemiological StudyJournal of Urology, VOL. 176, NO. 3, (1081-1085), Online publication date: 1-Sep-2006.Bacon C, Mittleman M, Kawachi I, Giovannucci E, Glasser D and Rimm E (2018) A Prospective Study of Risk Factors for Erectile DysfunctionJournal of Urology, VOL. 176, NO. 1, (217-221), Online publication date: 1-Jul-2006.Burnett A (2018) Erectile DysfunctionJournal of Urology, VOL. 175, NO. 3S, (S25-S31), Online publication date: 1-Mar-2006.O’Leary M, Althof S, Cappelleri J, Crowley A, Sherman N and Duttagupta S (2018) Self-Esteem, Confidence and Relationship Satisfaction of Men With Erectile Dysfunction Treated With Sildenafil Citrate: A Multicenter, Randomized, Parallel Group, Double-Blind, Placebo Controlled Study in the United StatesJournal of Urology, VOL. 175, NO. 3, (1058-1062), Online publication date: 1-Mar-2006.Shiri R, Koskimäki J, Häkkinen J, Tammela T, Auvinen A and Hakama M (2018) Effect of Nonsteroidal Anti-Inflammatory Drug Use on the Incidence of Erectile DysfunctionJournal of Urology, VOL. 175, NO. 5, (1812-1816), Online publication date: 1-May-2006.EL-SAKKA A and TAYEB K (2018) PEYRONIE'S DISEASE IN DIABETIC PATIENTS BEING SCREENED FOR ERECTILE DYSFUNCTIONJournal of Urology, VOL. 174, NO. 3, (1026-1030), Online publication date: 1-Sep-2005.Burnett A (2018) WIDENING THE SCOPE OF ERECTILE DYSFUNCTION RISK ASSOCIATIONSJournal of Urology, VOL. 174, NO. 1, (12-13), Online publication date: 1-Jul-2005.SHABSIGH R, PERELMAN M, LOCKHART D, LUE T and BRODERICK G (2018) HEALTH ISSUES OF MEN: PREVALENCE AND CORRELATES OF ERECTILE DYSFUNCTIONJournal of Urology, VOL. 174, NO. 2, (662-667), Online publication date: 1-Aug-2005.MONTAGUE D, JAROW J, BRODERICK G, DMOCHOWSKI R, HEATON J, LUE T, MILBANK A, NEHRA A and SHARLIP I (2018) CHAPTER 1: THE MANAGEMENT OF ERECTILE DYSFUNCTION: AN AUA UPDATEJournal of Urology, VOL. 174, NO. 1, (230-239), Online publication date: 1-Jul-2005.SUN P and SWINDLE R (2018) ARE MEN WITH ERECTILE DYSFUNCTION MORE LIKELY TO HAVE HYPERTENSION THAN MEN WITHOUT ERECTILE DYSFUNCTION? A NATURALISTIC NATIONAL COHORT STUDYJournal of Urology, VOL. 174, NO. 1, (244-248), Online publication date: 1-Jul-2005.DAYAN L, GREUNWALD I, VARDI Y and JACOB G (2018) A NEW CLINICAL METHOD FOR THE ASSESSMENT OF PENILE ENDOTHELIAL FUNCTION USING THE FLOW MEDIATED DILATION WITH PLETHYSMOGRAPHY TECHNIQUEJournal of Urology, VOL. 173, NO. 4, (1268-1272), Online publication date: 1-Apr-2005.SUETOMI T, HISASUE S, SATO Y, TABATA Y, AKAZA H and TSUKAMOTO T (2018) EFFECT OF BASIC FIBROBLAST GROWTH FACTOR INCORPORATING GELATIN MICROSPHERES ON ERECTILE FUNCTION IN THE DIABETIC RATJournal of Urology, VOL. 173, NO. 4, (1423-1428), Online publication date: 1-Apr-2005.BOCCHIO M, SCARPELLI P, NECOZIONE S, PELLICCIONE F, MHIALCA R, SPARTERA C, FRANCAVILLA F and FRANCAVILLA S (2018) INTIMA-MEDIA THICKENING OF COMMON CAROTID ARTERIES IS A RISK FACTOR FOR SEVERE ERECTILE DYSFUNCTION IN MEN WITH VASCULAR RISK FACTORS BUT NO CLINICAL EVIDENCE OF ATHEROSCLEROSISJournal of Urology, VOL. 173, NO. 2, (526-529), Online publication date: 1-Feb-2005.WALD M, SEFTEL A, ROSS L, MOHAMED M and NIEDERBERGER C (2018) COMPUTATIONAL MODELS FOR DETECTION OF ERECTILE DYSFUNCTIONJournal of Urology, VOL. 173, NO. 1, (167-170), Online publication date: 1-Jan-2005.PAVONE C, CURTO F, ANELLO G, SERRETTA V, ALMASIO P and PAVONE-MACALUSO M (2018) PROSPECTIVE, RANDOMIZED, CROSSOVER COMPARISON OF SUBLINGUAL APOMORPHINE (3 mg) WITH ORAL SILDENAFIL (50 mg) FOR MALE ERECTILE DYSFUNCTIONJournal of Urology, VOL. 172, NO. 6 Part 1, (2347-2349), Online publication date: 1-Dec-2004.KLONER R, JACKSON G, EMMICK J, MITCHELL M, BEDDING A, WARNER M and PEREIRA A (2018) INTERACTION BETWEEN THE PHOSPHODIESTERASE 5 INHIBITOR, TADALAFIL AND 2 α-BLOCKERS, DOXAZOSIN AND TAMSULOSIN IN HEALTHY NORMOTENSIVE MENJournal of Urology, VOL. 172, NO. 5, (1935-1940), Online publication date: 1-Nov-2004.TAYLOR J, KAO T, ALBERTSEN P and SHABSIGH R (2018) BICYCLE RIDING AND ITS RELATIONSHIP TO THE DEVELOPMENT OF ERECTILE DYSFUNCTIONJournal of Urology, VOL. 172, NO. 3, (1028-1031), Online publication date: 1-Sep-2004.EL-SAKKA A, MORSY A, FAGIH B and NASSAR A (2018) CORONARY ARTERY RISK FACTORS IN PATIENTS WITH ERECTILE DYSFUNCTIONJournal of Urology, VOL. 172, NO. 1, (251-254), Online publication date: 1-Jul-2004.SEFTEL A, SUN P and SWINDLE R (2018) THE PREVALENCE OF HYPERTENSION, HYPERLIPIDEMIA, DIABETES MELLITUS AND DEPRESSION IN MEN WITH ERECTILE DYSFUNCTIONJournal of Urology, VOL. 171, NO. 6 Part 1, (2341-2345), Online publication date: 1-Jun-2004.PIRILDAR T, MÜEZZINOĞLU T and PIRILDAR Ş (2018) SEXUAL FUNCTION IN ANKYLOSING SPONDYLITIS: A STUDY OF 65 MENJournal of Urology, VOL. 171, NO. 4, (1598-1600), Online publication date: 1-Apr-2004.BOCCHIO M, DESIDERI G, SCARPELLI P, NECOZIONE S, PROPERZI G, SPARTERA C, FRANCAVILLA F, FERRI C and FRANCAVILLA S (2018) ENDOTHELIAL CELL ACTIVATION IN MEN WITH ERECTILE DYSFUNCTION WITHOUT CARDIOVASCULAR RISK FACTORS AND OVERT VASCULAR DAMAGEJournal of Urology, VOL. 171, NO. 4, (1601-1604), Online publication date: 1-Apr-2004.USTA M, BIVALACQUA T, JABREN G, MYERS L, SANABRIA J, SIKKA S and HELLSTROM W (2018) Relationship Between the Severity of Penile Curvature and the Presence of Comorbidities in Men With Peyronie's DiseaseJournal of Urology, VOL. 171, NO. 2, (775-779), Online publication date: 1-Feb-2004.RHODEN E, GOBBI D, RHODEN C, MENTI E, ROEHE A, HARTMANN A and MORGENTALER A (2018) Effects of Chronic Administration of Dehydroepiandrosterone on Serum Testosterone Levels and Prostatic Tissue in RatsJournal of Urology, VOL. 170, NO. 5, (2101-2103), Online publication date: 1-Nov-2003.SHIRI R, KOSKIMÄKI J, HAKAMA M, HÄKKINEN J, TAMMELA T, HUHTALA H and AUVINEN A (2018) Prevalence and Severity of Erectile Dysfunction in 50 to 75-Year-Old Finnish MenJournal of Urology, VOL. 170, NO. 6, (2342-2344), Online publication date: 1-Dec-2003.TSUJIMURA A, MATSUMIYA K, MATSUOKA Y, TAKAHASHI T, KOGA M, IWASA A, TAKEYAMA M and OKUYAMA A (2018) Bioavailable Testosterone With Age and Erectile DysfunctionJournal of Urology, VOL. 170, NO. 6, (2345-2347), Online publication date: 1-Dec-2003.WESPES E, WILDSCHUTZ T, ROUMEGUERE T and SCHULMAN C (2018) The Place of Surgery for Vascular Impotence in the Third MillenniumJournal of Urology, VOL. 170, NO. 4 Part 1, (1284-1286), Online publication date: 1-Oct-2003.USTA M, BIVALACQUA T, YANG D, RAMANITHARAN A, SELL D, VISWANATHAN A, MONNIER V and HELLSTROM W (2018) The Protective Effect of Aminoguanidine on Erectile Function in Streptozotocin Diabetic RatsJournal of Urology, VOL. 170, NO. 4 Part 1, (1437-1442), Online publication date: 1-Oct-2003.COSTABILE R (2018) Optimizing Treatment for Diabetes Mellitus Induced Erectile DysfunctionJournal of Urology, VOL. 170, NO. 2S, (S35-S39), Online publication date: 1-Aug-2003.SIROKY M and AZADZOI K (2018) Vasculogenic Erectile Dysfunction: Newer Therapeutic StrategiesJournal of Urology, VOL. 170, NO. 2S, (S24-S30), Online publication date: 1-Aug-2003.KLONER R, MULLIN S, SHOOK T, MATTHEWS R, MAYEDA G, BURSTEIN S, PELED H, POLLICK C, CHOUDHARY R, ROSEN R and PADMA-NATHAN H (2018) Erectile Dysfunction in the Cardiac Patient: How Common and Should We Treat?Journal of Urology, VOL. 170, NO. 2S, (S46-S50), Online publication date: 1-Aug-2003.RAJPURKAR A and DHABUWALA C (2018) Comparison of Satisfaction Rates and Erectile Function in Patients Treated with Sildenafil, Intracavernous Prostaglandin E1 and Penile Implant Surgery for Erectile Dysfunction in Urology PracticeJournal of Urology, VOL. 170, NO. 1, (159-163), Online publication date: 1-Jul-2003.GONZALGO M, BROTZMAN M, TROCK B, GERINGER A, BURNETT A and JAROW J (2018) Clinical Efficacy of sildenafil Citrate and Predictors of Long-term ResponseJournal of Urology, VOL. 170, NO. 2, (503-506), Online publication date: 1-Aug-2003.SEFTEL A (2018) Erectile Dysfunction in the Elderly: Epidemiology, Etiology and Approaches to TreatmentJournal of Urology, VOL. 169, NO. 6, (1999-2007), Online publication date: 1-Jun-2003.MULHALL J (2018) Deciphering Erectile Dysfunction Drug TrialsJournal of Urology, VOL. 170, NO. 2, (353-358), Online publication date: 1-Aug-2003.MELMAN A, ZHAO W, DAVIES K, BAKAL R and CHRIST G (2018) The Successful Long-Term Treatment of Age Related Erectile Dysfunction with hSlo cDNA in Rats In VivoJournal of Urology, VOL. 170, NO. 1, (285-290), Online publication date: 1-Jul-2003.SPERLING H, EISENHARDT A, VIRCHOW S, HAUCK E, LENK S, PORST H, STIEF C, WETTERAUER U, RÜBBEN H, MÜLLER N and SIFFERT W (2018) Sildenafil Response is Influenced by the G Protein β3 Subunit Gnb3 C825t Polymorphism: A Pilot StudyJournal of Urology, VOL. 169, NO. 3, (1048-1051), Online publication date: 1-Mar-2003.De BERARDIS G, PELLEGRINI F, FRANCIOSI M, BELFIGLIO M, DI NARDO B, GREENFIELD S, KAPLAN S, ROSSI M, SACCO M, TOGNONI G, VALENTINI M and NICOLUCCI A (2018) Identifying patients with type 2 diabetes with a higher likelihood of erectile dysfunction: the role of the interaction between clinical and psychological factorsJournal of Urology, VOL. 169, NO. 4, (1422-1428), Online publication date: 1-Apr-2003.EL-SAKKA A and TAYEB K (2018) Erectile Dysfunction Risk Factors in Noninsulin Dependent Diabetic Saudi PatientsJournal of Urology, VOL. 169, NO. 3, (1043-1047), Online publication date: 1-Mar-2003.WYSOWSKI D and SWANN J (2018) Use of Medications for Erectile Dysfunction in the United States, 1996 Through 2001Journal of Urology, VOL. 169, NO. 3, (1040-1042), Online publication date: 1-Mar-2003.MacDONAGH R, EWINGS P and PORTER T (2018) THE EFFECT OF ERECTILE DYSFUNCTION ON QUALITY OF LIFE: PSYCHOMETRIC TESTING OF A NEW QUALITY OF LIFE MEASURE FOR PATIENTS WITH ERECTILE DYSFUNCTIONJournal of Urology, VOL. 167, NO. 1, (212-217), Online publication date: 1-Jan-2002.Rhoden E, Teloken C, Sogari P and Souto C (2018) The Relationship Of Serum Testosterone To Erectile Function In Normal Aging MenJournal of Urology, VOL. 167, NO. 4, (1745-1748), Online publication date: 1-Apr-2002.Hale T, Okabe H, Bushfield T, Heaton J and Adams M (2018) Recovery of Erectile Function after Brief Aggressive Antihypertensive TherapyJournal of Urology, VOL. 168, NO. 1, (348-354), Online publication date: 1-Jul-2002.Brock G, McMahon C, Chen K, Costigan T, Shen W, Watkins V, Anglin G and Whitaker S (2018) Efficacy and Safety of Tadalafil for the Treatment of Erectile Dysfunction: Results of Integrated AnalysesJournal of Urology, VOL. 168, NO. 4 Part 1, (1332-1336), Online publication date: 1-Oct-2002.Goldstein I, Lue T, Padma-Nathan H, Rosen R, Steers W and Wicker P (2018) Oral sildenafil in the treatment of erectile dysfunctionJournal of Urology, VOL. 167, NO. 2 Part 2, (1197-1203), Online publication date: 1-Feb-2002.MULHALL J, SLOVICK R, HOTALING J, AVIV N, VALENZUELA R, WATERS W and FLANIGAN R (2018) ERECTILE DYSFUNCTION AFTER RADICAL PROSTATECTOMY: HEMODYNAMIC PROFILES AND THEIR CORRELATION WITH THE RECOVERY OF ERECTILE FUNCTIONJournal of Urology, VOL. 167, NO. 3, (1371-1375), Online publication date: 1-Mar-2002.STOCK R, KAO J and STONE N (2018) PENILE ERECTILE FUNCTION AFTER PERMANENT RADIOACTIVE SEED IMPLANTATION FOR TREATMENT OF PROSTATE CANCERJournal of Urology, VOL. 165, NO. 2, (436-439), Online publication date: 1-Feb-2001.CHEN J, MABJEESH N, GREENSTEIN A, NADU A and MATZKIN H (2018) CLINICAL EFFICACY OF SILDENAFIL IN PATIENTS ON CHRONIC DIALYSISJournal of Urology, VOL. 165, NO. 3, (819-821), Online publication date: 1-Mar-2001.SIMOPOULOS D, GIBBONS S, MALYSZ J, SZURSZEWSKI J, FARRUGIA G, RITMAN E, MORELAND R and NEHRA A (2018) CORPOREAL STRUCTURAL AND VASCULAR MICRO ARCHITECTURE WITH X-RAY MICRO COMPUTERIZED TOMOGRAPHY IN NORMAL AND DIABETIC RABBITS: HISTOPATHOLOGICAL CORRELATIONJournal of Urology, VOL. 165, NO. 5, (1776-1782), Online publication date: 1-May-2001.HALE T, OKABE H, HEATON J and ADAMS M (2018) ANTIHYPERTENSIVE DRUGS INDUCE STRUCTURAL REMODELING OF THE PENILE VASCULATUREJournal of Urology, VOL. 166, NO. 2, (739-745), Online publication date: 1-Aug-2001.SARRAMON J, MALAVAUD B, BRAUD F, BERTRAND N, VAESSEN C and RISCHMANN P (2018) EVALUATION OF MALE SEXUAL FUNCTION BY THE INTERNATIONAL INDEX OF ERECTILE FUNCTION AFTER DEEP DORSAL VEIN ARTERIALIZATION OF THE PENISJournal of Urology, VOL. 166, NO. 2, (576-580), Online publication date: 1-Aug-2001.MARTIN-MORALES A, SANCHEZ-CRUZ J, SAENZ DE TEJADA I, RODRIGUEZ-VELA L, FERNANDO JIMENEZ-CRUZ J and BURGOS-RODRIGUEZ R (2018) PREVALENCE AND INDEPENDENT RISK FACTORS FOR ERECTILE DYSFUNCTION IN SPAIN: RESULTS OF THE EPIDEMIOLOGIA DE LA DISFUNCION ERECTIL MASCULINA STUDYJournal of Urology, VOL. 166, NO. 2, (569-575), Online publication date: 1-Aug-2001.TALCOTT J, CLARK J, STARK P and MITCHELL S (2018) LONG-TERM TREATMENT RELATED COMPLICATIONS OF BRACHYTHERAPY FOR EARLY PROSTATE CANCER: A SURVEY OF PATIENTS PREVIOUSLY TREATEDJournal of Urology, VOL. 166, NO. 2, (494-499), Online publication date: 1-Aug-2001.McVARY K, CARRIER S and WESSELLS H (2018) SMOKING AND ERECTILE DYSFUNCTION: EVIDENCE BASED ANALYSISJournal of Urology, VOL. 166, NO. 5, (1624-1632), Online publication date: 1-Nov-2001.MULHALL J, ABDEL-MONEIM A, ABOBAKR R and GOLDSTEIN I (2018) IMPROVING THE ACCURACY OF VASCULAR TESTING IN IMPOTENT MEN: CORRECTING HEMODYNAMIC ALTERATIONS USING A VASOACTIVE MEDICATION RE-DOSING SCHEDULEJournal of Urology, VOL. 166, NO. 3, (923-926), Online publication date: 1-Sep-2001.LEHMANN K, EICHLISBERGER R and GASSER T (2018) LACK OF DIAGNOSTIC TOOLS TO PROVE ERECTILE DYSFUNCTION: CONSEQUENCES FOR REIMBURSEMENT?Journal of Urology, VOL. 163, NO. 1, (91-94), Online publication date: 1-Jan-2000.Seftel A (2018) SEXUAL FUNCTION AND DYSFUNCTIONJournal of Urology, VOL. 163, NO. 2, (671-679), Online publication date: 1-Feb-2000.JOHANNES C, ARAUJO A, FELDMAN H, DERBY C, KLEINMAN K and McKINLAY J (2018) INCIDENCE OF ERECTILE DYSFUNCTION IN MEN 40 TO 69 YEARS OLD: LONGITUDINAL RESULTS FROM THE MASSACHUSETTS MALE AGING STUDYJournal of Urology, VOL. 163, NO. 2, (460-463), Online publication date: 1-Feb-2000.ROMEO J, SEFTEL A, MADHUN Z and ARON D (2018) SEXUAL FUNCTION IN MEN WITH DIABETES TYPE 2: ASSOCIATION WITH GLYCEMIC CONTROLJournal of Urology, VOL. 163, NO. 3, (788-791), Online publication date: 1-Mar-2000.BRIEN S, HEATON J, RACZ W and ADAMS M (2018) EFFECTS OF AN ENVIRONMENTAL ANTI-ANDROGEN ON ERECTILE FUNCTION IN AN ANIMAL PENILE ERECTION MODELJournal of Urology, VOL. 163, NO. 4, (1315-1321), Online publication date: 1-Apr-2000.BIVALACQUA T, DINER E, NOVAK T, VOHRA Y, SIKKA S, CHAMPION H, KADOWITZ P and HELLSTROM W (2018) A RAT MODEL OF PEYRONIE’S DISEASE ASSOCIATED WITH A DECREASE IN ERECTILE ACTIVITY AND AN INCREASE IN INDUCIBLE NITRIC OXIDE SYNTHASE PROTEIN EXPRESSIONJournal of Urology, VOL. 163, NO. 6, (1992-1998), Online publication date: 1-Jun-2000.CHEN J, CHIOU W, CHEN C and CHEN C (2018) EFFECT OF THE PLANT-EXTRACT OSTHOLE ON THE RELAXATION OF RABBIT CORPUS CAVERNOSUM TISSUE IN VITROJournal of Urology, VOL. 163, NO. 6, (1975-1980), Online publication date: 1-Jun-2000.JAIN P, RADEMAKER A and MCVARY K (2018) TESTOSTERONE SUPPLEMENTATION FOR ERECTILE DYSFUNCTION: RESULTS OF A META-ANALYSISJournal of Urology, VOL. 164, NO. 2, (371-375), Online publication date: 1-Aug-2000.KOSKIMÄKI J, HAKAMA M, HUHTALA H and TAMMELA T (2018) EFFECT OF ERECTILE DYSFUNCTION ON FREQUENCY OF INTERCOURSE: A POPULATION BASED PREVALENCE STUDY IN FINLANDJournal of Urology, VOL. 164, NO. 2, (367-370), Online publication date: 1-Aug-2000.McMAHON C, SAMALI R and JOHNSON H (2018) EFFICACY, SAFETY AND PATIENT ACCEPTANCE OF SILDENAFIL CITRATE AS TREATMENT FOR ERECTILE DYSFUNCTIONJournal of Urology, VOL. 164, NO. 4, (1192-1196), Online publication date: 1-Oct-2000.BURCHARDT M, BURCHARDT T, BAER L, KISS A, PAWAR R, SHABSIGH A, DE LA TAILLE A, HAYEK O and SHABSIGH R (2018) HYPERTENSION IS ASSOCIATED WITH SEVERE ERECTILE DYSFUNCTIONJournal of Urology, VOL. 164, NO. 4, (1188-1191), Online publication date: 1-Oct-2000.BURCHARDT T, BURCHARDT M, KARDEN J, BUTTYAN R, SHABSIGH A, de la TAILLE A, NG P, ANASTASIADIS A and SHABSIGH R (2018) REDUCTION OF ENDOTHELIAL AND SMOOTH MUSCLE DENSITY IN THE CORPORA CAVERNOSA OF THE STREPTOZOTOCIN INDUCED DIABETIC RATJournal of Urology, VOL. 164, NO. 5, (1807-1811), Online publication date: 1-Nov-2000.CHAMPION H, BIVALACQUA T, WANG R, KADOWITZ P, KEEFER L, SAAVEDRA J, HRABIE J, DOHERTY P and HELLSTROM W (2018) INDUCTION OF PENILE ERECTION BY INTRACAVERNOSAL AND TRANSURETHRAL ADMINISTRATION OF NOVEL NITRIC OXIDE DONORS IN THE CATJournal of Urology, VOL. 161, NO. 6, (2013-2019), Online publication date: 1-Jun-1999.COSTABILE R and SPEVAK M (2018) ORAL TRAZODONE IS NOT EFFECTIVE THERAPY FOR ERECTILE DYSFUNCTION: A DOUBLE-BLIND, PLACEBO CONTROLLED TRIALJournal of Urology, VOL. 161, NO. 6, (1819-1822), Online publication date: 1-Jun-1999.BIVALACQUA T, CHAMPION H, RAJASEKARAN M, SIKKA S, KADOWITZ P, DOHERTY P and HELLSTROM W (2018) POTENTIATION OF ERECTILE RESPONSE AND cAMP ACCUMULATION BY COMBINATION OF PROSTAGLANDIN E1 AND ROLIPRAM, A SELECTIVE INHIBITOR OF THE TYPE 4 PHOSPHODIESTERASE (PDE 4)Journal of Urology, VOL. 162, NO. 5, (1848-1855), Online publication date: 1-Nov-1999.MATHIAS S, O’LEARY M, HENNING J, PASTA D, FROMM S and ROSEN R (2018) A COMPARISON OF PATIENT AND PARTNER RESPONSES TO A BRIEF SEXUAL FUNCTION QUESTIONNAIREJournal of Urology, VOL. 162, NO. 6, (1999-2002), Online publication date: 1-Dec-1999.McMAHON C, SAMALI R and JOHNSON H (2018) TREATMENT OF INTRACORPOREAL INJECTION NONRESPONSE WITH SILDENAFIL ALONE OR IN COMBINATION WITH TRIPLE AGENT INTRACORPOREAL INJECTION THERAPYJournal of Urology, VOL. 162, NO. 6, (1992-1998), Online publication date: 1-Dec-1999.DROUPY S, HESSEL A, BENOÎT G, BLANCHET P, JARDIN A and GIULIANO F (2018) ASSESSMENT OF THE FUNCTIONAL ROLE OF ACCESSORY PUDENDAL ARTERIES IN ERECTION BY TRANSRECTAL COLOR DOPPLER ULTRASOUNDJournal of Urology, VOL. 162, NO. 6, (1987-1991), Online publication date: 1-Dec-1999.MELMAN A and GINGELL J (2018) THE EPIDEMIOLOGY AND PATHOPHYSIOLOGY OF ERECTILE DYSFUNCTIONJournal of Urology, VOL. 161, NO. 1, (5-11), Online publication date: 1-Jan-1999.LITWIN M (2018) HEALTH RELATED QUALITY OF LIFE IN OLDER MEN WITHOUT PROSTATE CANCERJournal of Urology, VOL. 161, NO. 4, (1180-1184), Online publication date: 1-Apr-1999.MULHALL J, JAHODA A, CAIRNEY M, GOLDSTEIN B, LEITZES R, WOODS J, PAYTON T, KRANE R and GOLDSTEIN I (2018) THE CAUSES OF PATIENT DROPOUT FROM PENILE SELF-INJECTION THERAPY FOR IMPOTENCEJournal of Urology, VOL. 162, NO. 4, (1291-1294), Online publication date: 1-Oct-1999.HANSON-DIVERS C, JACKSON S, LUE T, CRAWFORD S and ROSEN R (2018) HEALTH OUTCOMES VARIABLES IMPORTANT TO PATIENTS IN THE TREATMENT OF ERECTILE DYSFUNCTIONJournal of Urology, VOL. 159, NO. 5, (1541-1547), Online publication date: 1-May-1998.GUPTA S, SALIMPOUR P, DE TEJADA I, DALEY J, GHOLAMI S, DALLER M, KRANE R, TRAISH A and GOLDSTEIN I (2018) A POSSIBLE MECHANISM FOR ALTERATION OF HUMAN ERECTILE FUNCTION BY DIGOXIN: INHIBITION OF CORPUS CAVERNOSUM SODIUM/POTASSIUM ADENOSINE TRIPHOSPHATASE ACTIVITYJournal of Urology, VOL. 159, NO. 5, (1529-1536), Online publication date: 1-May-1998.Shabsigh R (2018) EDITORIAL: PENILE PROSTHESES TOWARD THE END OF THE MILLENIUMJournal of Urology, VOL. 159, NO. 3, (819-819), Online publication date: 1-Mar-1998.FULGHAM P, COCHRAN J, DENMAN J, FEAGINS B, GROSS M, KADESKY K, KADESKY M, CLARK A and ROEHRBORN C (2018) DISAPPOINTING INITIAL RESULTS WITH TRANSURETHRAL ALPROSTADIL FOR ERECTILE DYSFUNCTION IN A UROLOGY PRACTICE SETTINGJournal of Urology, VOL. 160, NO. 6 Part 1, (2041-2046), Online publication date: 1-Dec-1998.Helgason A, Adolfsson J, Dickman P, Arver S, Fredrikson M and Steineck G (2018) Factors Associated With Waning Sexual Function Among Elderly Men and Prostate Cancer PatientsJournal of Urology, VOL. 158, NO. 1, (155-159), Online publication date: 1-Jul-1997.Xie Y, Garban H, Ng C, Rajfer J and Gonzalez-Cadavid N (2018) Effect of Long-term Passive Smoking on Erectile Function and Penile Nitric Oxide Synthase in the RatJournal of Urology, VOL. 157, NO. 3, (1121-1126), Online publication date: 1-Mar-1997.Kifor I, Williams G, Vickers M, Sullivan M, Jodbert P and Dluhy R (2018) Tissue Angiotensin II as a Modulator of Erectile Function. I. Angiotensin Peptide Content, Secretion and Effects in the Corpus CavernosumJournal of Urology, VOL. 157, NO. 5, (1920-1925), Online publication date: 1-May-1997.Sogari P, Teloken C and Vargas Souto C (2018) ATROPINE ROLE IN THE PHARMACOLOGICAL ERECTION TEST: STUDY OF 228 PATIENTSJournal of Urology, VOL. 158, NO. 5, (1760-1763), Online publication date: 1-Nov-1997.Malmsten U, Milsom I, Molander U and Norlen L (2018) URINARY INCONTINENCE AND LOWER URINARY TRACT SYMPTOMS: AN EPIDEMIOLOGICAL STUDY OF MEN AGED 45 TO 99 YEARSJournal of Urology, VOL. 158, NO. 5, (1733-1737), Online publication date: 1-Nov-1997.Shabsigh R (2018) Editorial: Impotence on the Rise as a Urological SubspecialtyJournal of Urology, VOL. 155, NO. 3, (924-925), Online publication date: 1-Mar-1996.Godschalk M, Gheorghiu D, Chen J, Katz P and Mulligan T (2018) Long-term Efficacy of a New Formulation of Prostaglandin E1 as Treatment for Erectile FailureJournal of Urology, VOL. 155, NO. 3, (915-917), Online publication date: 1-Mar-1996.Cahn D, Melman A, Valcic M and Christ G (2018) Forskolin: A Promising New Adjunct to Intracavernous PharmacotherapyJournal of Urology, VOL. 155, NO. 5, (1789-1794), Online publication date: 1-May-1996.Nehra A, Goldstein I, Pabby A, Nugent M, Huang Y, de las Morenas A, Krane R, Udelson D, de Tejada I and Moreland R (2018) Mechanisms of Venous Leakage: A Prospective Clinicopathological Correlation of Corporeal Function and StructureJournal of Urology, VOL. 156, NO. 4, (1320-1329), Online publication date: 1-Oct-1996.Munarriz R, Yan Q, Nehra A, Udelson D and Goldstein I (2018) Blunt Trauma: The Pathophysiology of Hemodynamic Injury Leading to Erectile DysfunctionJournal of Urology, VOL. 153, NO. 6, (1831-1840), Online publication date: 1-Jun-1995.Tscholl R, Largo M, Poppinghaus E, Recker F and Subotic B (2018) Incidence of Erectile Impotence Secondary to Transurethral Resection of Benign Prostatic Hyperplasia, Assessed by Preoperative and Postoperative Snap Gauge TestsJournal of Urology, VOL. 153, NO. 5, (1491-1493), Online publication date: 1-May-1995.Hellstrom W, Monga M, Wang R, Domer F, Kadowitz P and Roberts J (2018) Penile Erection in the Primate: Induction with Nitric-Oxide DonorsJournal of Urology, VOL. 151, NO. 6, (1723-1727), Online publication date: 1-Jun-1994.Goldstein I (2018) Editorial: ImpotenceJournal of Urology, VOL. 151, NO. 6, (1533-1534), Online publication date: 1-Jun-1994. Volume 151Issue 1January 1994Page: 54-61 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.Keywordsagingpenile erectionimpotenceelderlyMetricsAuthor Information Henry A. Feldman More articles by this author Irwin Goldstein More articles by this author Dimitrios G. Hatzichristou More articles by this author Robert J. Krane More articles by this author John B. McKinlay More articles by this author Expand All Advertisement PDF downloadLoading ...

Oral Sildenafil in the Treatment of Erectile Dysfunction

1998-09-01

Irwin Goldstein , Tom F. Lue , Harin Padma-Nathan +3 more

Goldstein, Irwin; Lue, Tom F.; Padma-Nathan, Harin; Rosen, Raymond C.; Steers, William D.; Wicker, Pierre A. Author Information Goldstein, Irwin; Lue, Tom F.; Padma-Nathan, Harin; Rosen, Raymond C.; Steers, William D.; Wicker, Pierre A. Author Information

Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction.

1996-06-01

Mitra Boolell , Allen Mj , Ballard Sa +5 more

Sexual Behavior in the Human Female

1954-10-01

J. S. , Alfred C. Kinsey , W. B. Pomeroy +2 more

Sexual Behavior in the Human Female

1954-01-01

Carle C. Zimmerman , Alfred C. Kinsey , W. B. Pomeroy +2 more

Erectile Dysfunction: AUA Guideline

2018-05-07

Arthur L. Burnett , Ajay Nehra , Rodney H. Breau +7 more

You have accessJournal of UrologyAdult Urology1 Sep 2018Erectile Dysfunction: AUA Guidelineis corrected byErectile Dysfunction: AUA Guideline. Erratum Arthur L. Burnett, Ajay Nehra, Rodney H. Breau, Daniel J. Culkin, Martha M. … You have accessJournal of UrologyAdult Urology1 Sep 2018Erectile Dysfunction: AUA Guidelineis corrected byErectile Dysfunction: AUA Guideline. Erratum Arthur L. Burnett, Ajay Nehra, Rodney H. Breau, Daniel J. Culkin, Martha M. Faraday, Lawrence S. Hakim, Joel Heidelbaugh, Mohit Khera, Kevin T. McVary, Martin M. Miner, Christian J. Nelson, Hossein Sadeghi-Nejad, Allen D. Seftel, and Alan W. Shindel Arthur L. BurnettArthur L. Burnett More articles by this author , Ajay NehraAjay Nehra More articles by this author , Rodney H. BreauRodney H. Breau More articles by this author , Daniel J. CulkinDaniel J. Culkin More articles by this author , Martha M. FaradayMartha M. Faraday More articles by this author , Lawrence S. HakimLawrence S. Hakim More articles by this author , Joel HeidelbaughJoel Heidelbaugh More articles by this author , Mohit KheraMohit Khera More articles by this author , Kevin T. McVaryKevin T. McVary More articles by this author , Martin M. MinerMartin M. Miner More articles by this author , Christian J. NelsonChristian J. Nelson More articles by this author , Hossein Sadeghi-NejadHossein Sadeghi-Nejad More articles by this author , Allen D. SeftelAllen D. Seftel More articles by this author , and Alan W. ShindelAlan W. Shindel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.05.004AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract Purpose: The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction. Materials and Methods: A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1965 to 7/29/17) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of erectile dysfunction. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions. Results: The American Urological Association has developed an evidence-based guideline on the management of erectile dysfunction. This document is designed to be used in conjunction with the associated treatment algorithm. Conclusions: Using the shared decision-making process as a cornerstone for care, all patients should be informed of all treatment modalities that are not contraindicated, regardless of invasiveness or irreversibility, as potential first-line treatments. For each treatment, the clinician should ensure that the man and his partner have a full understanding of the benefits and risk/burdens associated with that choice. Background The sexual response cycle is conceptualized as a sequential series of psychophysiological states that usually occur in an orderly progression. These phases were characterized by Masters and Johnson as desire, arousal, orgasm, and resolution. Erectile dysfunction (ED) can be conceptualized as an impairment in the arousal phase of sexual response and is defined as the consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction, including satisfactory sexual performance.1,2 The Panel believes that shared decision-making is the cornerstone of the treatment and management of ED, a model that relies on the concepts of autonomy and respect for persons in the clinical encounter. It is also a process in which the patient and the clinician together determine the best course of therapy based on a discussion of the risks, benefits and desired outcome. Using this approach, all men should be informed of all treatment options that are not medically contraindicated to determine the appropriate treatment. Although many men may choose to begin with the least invasive option, the Panel notes that it is valid for men to begin with any type of treatment, regardless of invasiveness or reversibility. Men also may choose to forego treatment. In each scenario, the clinician’s role is to ensure that the man and his partner have a full understanding of the benefits and risks/burdens of the various management strategies (see supplementary figure, http://jurology.com/). Guideline Statements For more information on the American Urological Association (AUA) nomenclature system that was used to arrive at statement type and body of evidence strength see table 1 in the supplementary unbridged guideline (http://jurology.com/). 1. Men presenting with symptoms of ED should undergo a thorough medical, sexual and psychosocial history, a physical examination, and selective laboratory testing. (Clinical Principle) 2. For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion) 3. Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle) 4. In men with ED, morning serum total testosterone levels should be measured. (Moderate Recommendation; Evidence Level: Grade C) 5. For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opinion) 6. For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C) When the man’s presenting concern is ED, a comprehensive evaluation and targeted physical exam should be performed. Given that many men are uncomfortable broaching sexual concerns with a physician, it is critical that the physician initiate the inquiry.3 Validated questionnaires may provide an opportunity to initiate a conversation about ED; examples include the Erection Hardness Score4 and the Sexual Health Inventory for Men.5 General medical history factors to consider when a man presents with ED are age, comorbid medical and psychological conditions, prior surgeries, medications, family history of vascular disease, and substance use. Key questions regarding ED include identifying the onset of symptoms, symptom severity, degree of bother, specification of whether the problem involves attaining and/or maintaining an erection, situational factors (e.g., occurring only in specific contexts, only when with a partner, only with specific partners), the presence of nocturnal and/or morning erections, the presence of masturbatory erections, and prior use of erectogenic therapy.6 The presence of nocturnal and/or morning erections suggests (but does not confirm) a psychogenic component to ED symptoms that would benefit from further investigation. Vital signs including pulse and resting blood pressure should be assessed. Genital examination should include assessment of penile skin lesions and placement/configuration of the urethral meatus. Examination of the penis for occult deformities or plaque lesions should occur with the penis held stretched and palpated from the pubic bone to the coronal sulcus.7 The presence/absence of a palpable plaque should not be taken as definitive evidence for clinically relevant penile deformity such as Peyronie’s Disease. If Peyronie’s Disease is suspected, then additional diagnostic procedures should be undertaken. Digital rectal examination is not required for evaluation of ED; however, benign prostate hyperplasia is a common comorbid condition in men with ED and may merit evaluation and treatment. With the possible exception of glucose/hemoglobin A1c and serum lipids, no routine serum study is likely to alter ED management. Serum total testosterone should be measured in all men with ED to determine if testosterone deficiency (TD), defined as total testosterone <300 ng/dL with the presence of symptoms and signs, is present. For complete information on TD, please see the AUA guideline on the evaluation and management of testosterone deficiency.8 Psychological factors (e.g., depression, anxiety, relationship conflict) and psychosexual issues may be primary or secondary contributors to ED.9,10 Thoughtful discussion of these issues with men and their partners is a key component of patient education and can promote acceptance of incorporating a mental health/sexuality expert into the treatment plan. Psychotherapy and psychosexual counseling focus on helping patients and their partners improve communication about sexual concerns, reducing anxiety related to entering and during a sexual situation, and introducing strategies for integrating ED treatments into their sexual relationship. For men with predominantly psychogenic ED, providers should offer a referral to a psychotherapist as either an alternative or adjunct to medical treatment to ED. Risk markers are attributes that predict increased probability of a disease state but are not part of the causal pathway; ED is a risk marker for systemic cardiovascular disease. The Princeton Consensus Conference, an inter-specialty meeting centered on preserving cardiac function and optimizing sexual health, has identified ED as a substantial independent risk marker for cardiovascular disease. Findings from the Prostate Cancer Prevention Trial indicated that the presence of ED was as strong a predictor of future cardiac events as cigarette smoking or a family history of myocardial infarction.11 The diagnosis of ED provides a pivotal opportunity to discuss cardiovascular risk. The clinician should communicate this increased risk to the man with ED, to his partner, and to other relevant clinicians (i.e. the primary care provider) so that appropriate referrals and interventions can be discussed and implemented. For some men with ED, generally those who present with complex histories, specialized testing and evaluation may be necessary. These tests include nocturnal penile tumescence and rigidity testing; intracavernosal injection (ICI); penile duplex ultrasound (which may be combined with ICI to produce a more detailed and quantitative assessment of penile vascular response);12 cavernosometry; and selective internal pudendal angiography. 7. Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Moderate Recommendation; Evidence Level: Grade C) The presence of ED indicates the likely presence of other comorbid conditions and risk factors, particularly cardiovascular risk factors and obesity.13 Diverse literature that focused on lifestyle changes, primarily healthier diets and increased exercise, indicate that these interventions may have small positive effects on erectile function (EF) and broader, positive effects on overall health. The diagnosis of ED, and the associated interference with sexual life, may motivate re-evaluation of lifestyle choices and create the motivation for behavioral changes that ultimately may reduce future vascular risks and improve erectile function. The man’s presentation for evaluation of ED therefore creates an opportunity for the clinician to emphasize to him and his partner the importance of a healthy lifestyle to general health and quality of life, but also to support optimal erectile function and increase the probability that ED treatments will be effective. 8. Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B) 9. When men are prescribed an oral PDE5i for the treatment of ED, instructions should be provided to maximize benefit/efficacy. (Strong Recommendation; Evidence Level: Grade C) 10. For men who are prescribed PDE5i, the dose should be titrated to provide optimal efficacy. (Strong Recommendation; Evidence Level: Grade B) The FDA-approved oral phosphodiesterase type 5 inhibitors (PDE5i) available for management of ED in the U.S. include sildenafil, tadalafil, vardenafil, and avanafil. Several other PDE5i have been approved for use in other countries. PDE5i medications have been extensively studied, with nearly a quarter of a million men evaluated from the general ED population and approximately 25,000 men evaluated from various special populations including those with specific underlying conditions (e.g., diabetes, benign prostate hyperplasia/lower urinary tract symptoms, post radical prostatectomy). Data from individual studies and trials, including analyses that pooled data across multiple trials14-17 and reports of published systematic reviews18 suggest that sildenafil, tadalafil, and vardenafil, and avanafil have similar efficacy in the general ED population, dose-response effects across PDE5i medications are small and non-linear, and on demand dosing versus daily dosing for tadalafil appears to produce the same level of efficacy. Fewer studies focused on special populations, but in general findings are similar to those reported in the general ED population.19-26 The data suggest, however, that men with diabetes and men who are post-prostatectomy have more severe ED at baseline and respond less robustly to PDE5i. The most frequently reported adverse events (AEs) in men using PDE5i are dyspepsia, headache, flushing, back pain, nasal congestion, myalgia, visual disturbance, and dizziness (table 2 in supplementary unbridged guideline, http://jurology.com/). Average rates are similar across medications with the exception of dyspepsia (lowest rates reported with avanafil), flushing (lowest rates reported with tadalafil), and myalgia (lowest rates reported with vardenafil and avanafil). Most AEs followed a dose-response pattern such that men who were randomized to active treatment reported statistically significantly higher rates of AEs than did men who were randomized to placebo; the percentage of men reporting a particular AE increased as dose increased. The use of nitrate-containing medications in combination with a PDE5i can cause a precipitous drop in blood pressure. As such, men taking nitrates regularly should not use PDE5i medications. In men with mild to moderate hepatic or renal impairment or men with spinal cord injury, PDE5i should be used with caution at least initially at lower doses given the potential for delayed metabolism. In men with severe renal or liver disease, use of PDE5i is generally not recommended. Given that incorrect use of PDE5i (e.g., lack of sexual stimulation, medication taken with a large meal) accounts for a large percentage of treatment failures, men who are prescribed a PDE5i should be carefully instructed in the appropriate use of the medication. In particular, it should be explained that sexual stimulation is necessary and that more than one trial with the medication may be required to establish efficacy. When prescribing a PDE5i, the clinician must balance the goals of the man and his partner for successful sexual activity, the need to prescribe an effective PDE5i dose, and the need to minimize AEs. The clinician should work with the man and his partner to find the dose that meets treatment expectations without resulting in unacceptable levels of AEs. This process may require that initial doses be titrated up or down until the optimal dose is identified. 11. Men who desire preservation of erectile function after treatment for prostate cancer by radical prostatectomy (RP) or radiotherapy (RT) should be informed that early use of PDE5i post-treatment may not improve spontaneous, unassisted erectile function. (Moderate Recommendation; Evidence Level: Grade C) The development of cavernous nerve-sparing surgical procedures (i.e., the application of techniques that preserve the peri-prostatic penile nerve supply required for penile erection) has led to improved rates of erectile function recovery after radical pelvic surgery.27 Even with nerve-sparing techniques many men will experience ED after pelvic operations.28 Similarly, modifications in the delivery of radiation for pelvic malignancies have resulted in better erection preservation after treatment.29 However, ED remains common after pelvic radiation, with approximately 36% of patients reporting new-onset ED at 2 years post-treatment.30 Strategies for penile rehabilitation aim to prevent or reduce the extent of long-term erectile impairment and/or latency of erectile function recovery. The objective of these strategies is to counteract pathophysiologic mechanisms of erectile dysfunction induced by prostate cancer treatments. PDE5i have been investigated most extensively for the purpose of penile rehabilitation because of their non-invasiveness and ease of administration. Trials have not demonstrated that early PDE5i use (i.e., within 45 days of prostate cancer therapy) improves unassisted EF, although most studies reported that PDE5i are effective in assisting erections on-demand during the course of the trial. Psychosocial support is also an integral component of the penile rehabilitation strategy. Given the impact of ED after prostate cancer treatment, particularly its suddenness and severity for many men undergoing radical prostatectomy, it is not surprising that men in this setting commonly experience depression, anxiety and relationship stress.31 Clinicians should educate men regarding the sexual effects of prostate cancer treatments and set realistic expectations regarding functional recovery, including the possibility that recovery may be more challenging for men who have multiple ED risk factors. 12. Men with ED and testosterone deficiency (TD) who are considering ED treatment with a PDE5i should be informed that PDE5i may be more effective if combined with testosterone therapy. (Moderate Recommendation; Evidence Level: Grade C) If a man with ED is also diagnosed with TD, then he should be counseled that testosterone therapy in combination with a PDE5i is more likely to be effective than the PDE5i alone. Testosterone therapy is not an effective monotherapy for ED;32 if the man’s goal is amelioration of ED symptoms, then he should be counseled regarding the need for ED therapies in addition to testosterone therapy. However, testosterone therapy may provide some global health benefits (e.g., improved bone density). For detailed information on possible health benefits of testosterone therapy, AEs associated with testosterone therapy, and recommended monitoring protocols for men prescribed testosterone, refer to the AUA guideline on the evaluation and management of testosterone deficiency.8 13. Men with ED should be informed regarding the treatment option of a vacuum erection device (VED), including discussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C) Vacuum erection devices (VED) are associated with high rates of patient and partner satisfaction (mean 77% for both patients and partners) and are an effective and low-cost treatment option for select men with ED. They are effective in the general ED population as well as in men with diabetes, spinal cord injury, post-prostatectomy, and other conditions.33,34 Only VEDs containing a vacuum limiter should be used. VED may be purchased over-the-counter or procured via prescription. Clinicians should counsel men with ED prior to beginning VED treatment about the potential occurrence of AEs. Most AEs are minor and resolved without intervention, and include: transient penile petechiae or bruising; discomfort or pain; difficulty with ejaculation; and difficulty with the device. Men who are receiving anti-coagulant therapy and/or who have bleeding disorders or have a history of priapism should use VEDs with caution. 14. Men with ED should be informed regarding the treatment option of intraurethral (IU) alprostadil, including discussion of benefits and risks/burdens. (Conditional Recommendation; Evidence Level: Grade C) 15. For men with ED who are considering the use of IU alprostadil, an in-office test should be performed. (Clinical Principle) Intraurethral (IU) medication involves the insertion of a delivery catheter into the meatus and depositing an alprostadil (prostaglandin E1) pellet in the urethra to induce an erection sufficient for intercourse. IU alprostadil is a treatment option for men for whom PDE5i are contraindicated, for men or partners who prefer to avoid oral medication, and/or for men or partners who prefer not to use the needles required for ICI medications.35,36 The largest study to assess the efficacy of IU alprostadil reported that of the 461 men assigned to the alprostadil condition, 299 (64.9%) achieved at least one episode of intercourse at home,37 while other studies reported successful intercourse rates from 29.5% to 78.1%. IU alprostadil should not be prescribed until a man has undergone instruction in the technique, an initial dose-titration in the office, and detailed counseling regarding possible AEs. 16. Men with ED should be informed regarding the treatment option of intracavernosal injections (ICI), including discussion of benefits and risks/burdens. (Moderate Recommendation, Evidence Level: Grade C) 17. For men with ED who are considering ICI therapy, an in-office injection test should be performed. (Clinical Principle) ICI medications are administered by injecting alprostadil, papaverine, phentolamine, and/or atropine into the corpus cavernosum of the penis to produce an erection. Only alprostadil is FDA-approved in the U.S. for ICI injection, and it is the only medication typically used as a single agent. The three other medications with established efficacy for ED are typically used in combination with one another (e.g., papaverine + phentolamine, alprostadil + papaverine + phentolamine; alprostadil + papaverine + phentolamine + atropine). Men who have contraindications to the use of PDE5i, prefer not to take an oral medication, or find that PDE5i are inadequate or ineffective, may choose the ICI approach to treating ED. ICI medications are effective in diverse groups of men, including men from the general ED population as well as among men with other conditions such as diabetes, cardiovascular risk factors, men who are post-prostatectomy, and men with spinal cord injuries.38-42 The most commonly used outcome measure in ICI studies is the percentage of men who reported achieving an erection sufficient for successful intercourse. These percentages ranged from 53.7% to 100% without marked differences across medications or medication combinations. The second most commonly used outcome measure was the percent of men who reported being satisfied with the treatment. These percentages ranged from 46.3% to 98.8% with the lowest satisfaction rates associated with papaverine use (mean 53.4%). Men should be thoroughly counseled regarding the potential differential risk profiles of the various ICI substances. The most serious AE associated with ICI medications is priapism with lowest rates of priapism (mean 1.8%) reported in studies using alprostadil. The Panel notes that identifying the appropriate dose of medication and instructing the man in dose titration is critical to minimize the risk of priapism. Pain is also a common consequence of ICI injections; the literature suggests that pain rates are highest when papaverine or alprostadil are used as single agents, and when papaverine is used in combination with phentolamine. Penile fibrosis or plaque and penile deformities have been reported with use of ICI with considerable range across medications (4.5% - 13%). Men considering ICI therapy should first have an in-office injection test,42 and should be informed that although injectable non-prostaglandin agents have been used to successfully manage ED for decades, none are formally FDA-approved for this indication. 18. Men with ED should be informed regarding the treatment option of penile prosthesis implantation, including discussion of benefits and risks/burdens. (Strong Recommendation, Evidence Level: Grade C) 19. Men with ED who have decided on penile implantation surgery should be counseled regarding post-operative expectations. (Clinical Principle) 20. Penile prosthetic surgery should not be performed in the presence of systemic, cutaneous, or urinary tract infection. (Clinical Principle) Prosthesis implantation has been performed successfully in men from the general ED population as well as in men from a variety of special populations.43 Men and their partners should be thoroughly counseled regarding the benefits and potential risks of this treatment to ensure appropriate choice of device, realistic post-operative expectations, and potential for high satisfaction.44 Men and their partners should be counseled regarding AEs in the peri- and post-operative period, including penile edema or hematoma, corporeal injury, urethral injury, and acute urinary retention. These AEs are rarely serious and generally resolve with supportive care or minimal intervention. Infection is a serious AE that typically occurs within the first three months after surgery and usually requires removal of the prosthesis. Although no randomized studies have compared outcomes between prosthesis models with and without infection-inhibiting coatings, observational studies indicate that coated models have greatly reduced infection rates with most series reporting rates of 1-2% when these models are implanted.45,46 Given the invasive and essentially irreversible nature of penile prosthesis implantation surgery, counseling regarding short- and long-term postoperative expectations is essential. The Panel notes that penile prosthesis surgery should not be undertaken if the man has evidence of systemic or cutaneous infections or if he has a urinary tract infection. 21. For young men with ED and focal pelvic/penile arterial occlusion and without documented generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction may be considered. (Conditional Recommendation, Evidence Level: Grade C) Penile arterial reconstruction surgery may be considered for the man with ED who is young and who does not have veno-occlusive dysfunction or any evidence of generalized vascular disease or other comorbidities that could compromise vascular integrity. Overall, data indicate that predicting whether arterial reconstructive surgery will result in long-term success for a given man is extremely difficult, even in men without comorbidities and with good vascular health. In addition, proper diagnosis requires a thorough investigation. A recent study reported that nearly 50% of men initially identified as good candidates for arterial reconstruction were not properly diagnosed.47 22. For men with ED, penile venous surgery is not recommended. (Moderate Recommendation, Evidence Level: Grade C) Penile venous surgery is not recommended because of the lack of compelling evidence that it constitutes an effective ED management strategy in most men. Randomized trials of men who underwent various versions of penile venous ligation surgery indicate that penile venous ligation surgery is unlikely to result in long-term successful management of ED for the overwhelming majority of men and delays treatment with other more reliable options such as penile prosthesis surgery.48 23. For men with ED, low-intensity extracorporeal shock wave therapy should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) 24. For men with ED, intracavernosal stem cell therapy should be considered investigational. (Conditional Recommendation; Evidence Level: Grade C) 25. For men with ED, platelet-rich plasma therapy should be considered experimental. (Expert Opinion) Findings from randomized sham-controlled trials that have evaluated low-intensity extracorporeal shock wave therapy and ICI stem cell therapy do not clearly indicate that benefits reliably outweigh risks/burdens for men with ED, and these tr

Erectile dysfunction

2012-10-05

Rany Shamloul , Hussein Ghanem

Erectile Dysfunction

2000-06-15

Tom F. Lue

Erectile dysfunction is defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse.1 It has been estimated to affect 20 million to 30 million … Erectile dysfunction is defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse.1 It has been estimated to affect 20 million to 30 million men in the United States.2,3 It may result from psychological, neurologic, hormonal, arterial, or cavernosal impairment or from a combination of these factors. In this article we provide a brief overview of the physiology of erection and the pathophysiology of erectile dysfunction, followed by a discussion of drug treatment for the disorder.Physiology of Penile ErectionPenile erection is a neurovascular event modulated by psychological factors and hormonal status. . . .

Pharmacology of lower urinary tract smooth muscles and penile erectile tissues.

1993-09-01

K.‐E. Anderson

Sexual Quality of Life in Postmenopausal Women: A Comparative Randomized Controlled Trial of Intravaginal PRP Therapy Versus Local Hormonal Treatments

2025-06-25

Geanina Sacarin , Ahmed Abu-Awwad , Nitu Razvan +7 more | Medicina

Background and Objectives: Genitourinary syndrome of menopause (GSM) is a prevalent and distressing condition in postmenopausal women, often leading to sexual dysfunction characterized by vaginal dryness, pain, and reduced libido. … Background and Objectives: Genitourinary syndrome of menopause (GSM) is a prevalent and distressing condition in postmenopausal women, often leading to sexual dysfunction characterized by vaginal dryness, pain, and reduced libido. While local estrogen therapy remains the standard treatment, due to safety concerns and contraindications, there is growing interest in the exploration of alternative interventions. This study aimed to compare the effectiveness and safety of intravaginal platelet-rich plasma (PRP) therapy versus local hormonal treatment in improving sexual function and vaginal health in postmenopausal women. Materials and Methods: A prospective, controlled clinical trial was conducted between January 2023 and December 2024 across three private gynecology clinics in Timișoara, Romania. Ninety postmenopausal women aged between 50 and 65 years with FSFI scores ≤ 23 were randomized into two groups: one receiving three monthly sessions of autologous PRP and the other undergoing 12 weeks of vaginal estriol therapy. Outcomes were assessed using validated tools—the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI), the Patient Global Impression of Improvement (PGI-I), and patient satisfaction scores—at baseline, week 6, and week 12. Results: Both of the treatment groups demonstrated significant improvements in FSFI and VHI scores at 12 weeks, with the PRP group showing a slightly higher, though not statistically significant, mean increase in the total FSFI (+10.1 vs. +9.3 points). Clinical gains were also observed in lubrication, elasticity, and dyspareunia. Patient satisfaction was high in both groups (93.3% PRP vs. 88.9% hormonal), and there were no reports of serious adverse events during the study period. The PRP group exhibited fewer side effects, without systemic symptoms, supporting its favorable safety profile. Conclusions: PRP therapy is a well-tolerated, hormone-free treatment that offers clinically meaningful improvements in sexual function and vaginal health, comparable to estrogen therapy. It may be particularly beneficial for women with contraindications to hormones or in advanced postmenopause. Further long-term studies are needed to confirm these findings and optimize treatment protocols.

Long-term outcomes of superselective transcatheter embolization in high-flow priapism

2025-06-25

Arianna Biasatti , Andrea Piasentin , Giulio Rossin +5 more | International Journal of Impotence Research

Cross-sectional study of the association between regular sexual activity and sexual function and genitourinary syndrome of menopause–related symptoms

2025-06-24

Yoshikazu Sato , Yumi Ozaki , Hikaru Tomoe +4 more | Menopause The Journal of The North American Menopause Society

Objectives: We assessed sexual symptoms and function in perimenopausal and postmenopausal Japanese women and examined the association between sexual regularity and their symptoms. Methods: Sexually active women aged 40-79 (n … Objectives: We assessed sexual symptoms and function in perimenopausal and postmenopausal Japanese women and examined the association between sexual regularity and their symptoms. Methods: Sexually active women aged 40-79 (n = 911) were selected from the genitourinary syndrome of menopause (GSM) in Japanese Women study (n = 4,134) and then divided into 2 groups: regular sexual activity group, which comprised women with sexual activity in the past 3 months (n = 716), and lower sexual activity group, which comprised women with sexual activity in the past year but not in the past 3 months (n = 195). We evaluated sexual function and symptoms in the regular sexual activity group using the Female Sexual Function Index and compared GSM-related symptoms between the two groups. Results: Sexual desire, arousal, and lubrication ability declined significantly with age. Sexual pain increases with age. However, orgasm and satisfaction did not decline significantly with age. Regular and lower sexual activity groups did not differ significantly in sexual symptoms; however, vulvar symptoms in daily life were significantly lower in the regular sexual activity group than in the lower activity group. Sexual activity in the past 3 months was associated with lower odds of vulvar pain, dryness, and irritation. Conclusions: This study reveals an association between regular sexual activity and low prevalence of GSM-related symptoms in daily life. The direction of this relationship could not be evaluated in this study and needs to be explored using prospective studies.

A cavernous tissue without a blood pool that appears under the tunica albuginea during erection

2025-06-23

Y Kawanishi , Takeshi Miyake , Masahito Yamanaka | BJU International

A Morpho-Functional Assessment of the Vulvar Vestibule in Patients With Vestibulodynia: A Case-Control Study

2025-06-23

Filippo Murina , Cecilia Fochesato , Stefania Di Francesco +3 more | Journal of Lower Genital Tract Disease

The aim of the study was to investigate the morpho-functional characteristics of the vulvar vestibule in women with provoked vestibulodynia (PVD), comparing clinical, structural, and sensory parameters with healthy controls. … The aim of the study was to investigate the morpho-functional characteristics of the vulvar vestibule in women with provoked vestibulodynia (PVD), comparing clinical, structural, and sensory parameters with healthy controls. This was a case-control study including 30 women diagnosed with PVD and 30 healthy controls. The following morpho-functional characteristics were considered: (i) vestibular trophism, (ii) vestibular epithelial thickness, (iii) pelvic floor muscle hypertonia, and (iv) vestibular current perception threshold evaluation, at 3 frequencies (2000 Hz, 250 Hz, and 5 Hz). Fisher's exact test and Mann-Whitney U test were used to compare parameters between PVD cases and healthy controls, while Pearson's correlation coefficient was calculated to assess vestibular trophism and epithelial thickness with neurosensitization. PVD patients compared to healthy controls showed higher vestibular trophism health score (6.5 vs 3.0, p < .001), lower epithelial thickness (987.0 vs 1159.0 μm, p < .001), more frequently hypertonia of pelvic floor muscle (p < .001), and lower thresholds at neurosensitization at all three frequencies. A linear negative correlation emerged between vestibular trophism health score and current perception threshold at 5 Hz (r = -0.53, p = .003) and 250 Hz (r = -0.45, p = .013) in PVD cases. No significant correlation emerged for controls and for both groups for current perception threshold at 2000 Hz. This study identified substantial organic differences between PVD patients and healthy controls in critical parameters, such as vestibular trophism, epithelial thickness, pelvic floor muscle hypertonia, and neurosensitization. These findings enhance understanding of the complex and multifactorial mechanisms underlying PVD and highlight potential therapeutic targets for intervention.

Case 1: Clitoromegaly, Oligomenorrhea, and Hirsutism in a 17-year-old Transgender Male

2025-06-23

| American Academy of Pediatrics eBooks

The relationship between depression, stress, anxiety and personality traits with sexual function levels among women

2025-06-23

Halime Esra MERAM , Ebru BEKMEZCİ | Health Care For Women International

In this study, we aimed to determine the relationship between women's depression, stress, anxiety, and personal traits with their sexual function levels. We conducted cross-sectional study, among 215 women with … In this study, we aimed to determine the relationship between women's depression, stress, anxiety, and personal traits with their sexual function levels. We conducted cross-sectional study, among 215 women with sexually active women. We collected the research data by utilizing "Introductory Information Form", "Depression, Anxiety, Stress Scale (DASS)", "Female Sexual Function Index (FSFI)" and "International Personality Inventory Short Form (IPISV)". Among the participants, 63.7% exhibited adequate levels of sexual function, and 87.9% reported satisfaction with their sexual life. We found a weak negative correlation between total FSFI scores and some sub-dimensions of the IPISV, and the DASS. Higher levels of psychological distress and marked by emotional instability, hostility, undirectedness, and closed to experience, were associated with reduced levels of sexual function. It appears that psychological and personality factors may be relevant in understanding variations in sexual function, indicating the potential value of targeted interventions in improving sexual function.

The critical role of PDGFRa + Sca1 + fibroblasts in angiogenesis and vascular repair in the corpus cavernosum

2025-06-20

Biao Liu , Zitaiyu Li , Zhitao Han +7 more | Stem Cell Research & Therapy

Erectile dysfunction (ED) is an important cause of reduced quality of life for men and their partners. A common pathological feature across various types of ED, including diabetes mellitus-induced ED … Erectile dysfunction (ED) is an important cause of reduced quality of life for men and their partners. A common pathological feature across various types of ED, including diabetes mellitus-induced ED (DMED) and bilateral cavernous nerve injury-induced ED (CNIED), is the loss of endothelial cells (ECs) and smooth muscle cells (SMCs) in the corpus cavernosum (CC). Stem cell-based therapies have garnered attention due to their potential to differentiate into specialized cell types, offering promise for the treatment of ED. Fibroblasts (FBs), the most abundant cell type in the CC, have raised considerable interest in recent years. However, the functional role of FBs in the progression of ED remains unclear. We established DMED and CNIED animal models and performed single-cell RNA sequencing (scRNA-seq) to analyze cell subsets within the pathological environments of these two ED types. To further investigate the cellular landscape, we combined spatial transcriptomics with scRNA-seq and multiplexed immunofluorescence to identify specific FB subsets in the CC. scRNA-seq revealed a distinct subset of FBs that overexpress both Sca1 and PDGFRa. CytoTRACE analysis and Gene Set Enrichment Analysis (GSEA) indicated that PDGFRa + Sca1 + FBs may be associated with angiogenesis and possess the potential to differentiate into ECs and SMCs. Immunofluorescence analysis confirmed that PDGFRa + Sca1 + FBs were localized to the vessel walls, with co-localization of Sca1 and PDGFRa observed with markers for SMCs and ECs. Our findings shed light on the role of PDGFRa + Sca1 + FBs in the CC, demonstrating their involvement in angiogenesis and vascular repair. The depletion of these FBs in disease conditions may contribute to the exhaustion of ECs and SMCs, providing new insights into the pathogenesis of ED. These results open potential avenues for novel therapeutic strategies aimed at targeting PDGFRa + Sca1 + FBs to restore vascular function in ED.

Efficacy of vacuum erectile device in refractory erectile dysfunction: a systematic review and meta-analysis

2025-06-20

Fuxun Zhang , Zhirong Luo , Qi Xue +6 more | International Journal of Impotence Research

Collagen fleece versus porcine small intestinal submucosa grafting for Peyronie's disease: A comparative analysis

2025-06-20

Pedro Ramos , Margarida Henriques , Alberto Costa Silva +3 more | Andrology

Abstract Background Peyronie's disease (PD) is a fibrotic disorder affecting the tunica albuginea, leading to penile curvature and deformity, significantly impacting sexual function and quality of life. Surgical correction remains … Abstract Background Peyronie's disease (PD) is a fibrotic disorder affecting the tunica albuginea, leading to penile curvature and deformity, significantly impacting sexual function and quality of life. Surgical correction remains the gold standard for patients with severe curvature, yet the optimal grafting material remains undetermined. Small intestinal submucosa (SIS) and collagen fleece (CF) grafts are widely used, but their comparative efficacy is still debated. Objectives Our aim is to compare the clinical outcomes of SIS and CF grafting techniques in penile lengthening procedures for PD, evaluating postoperative outcomes and patient satisfaction. Materials and Methods A retrospective cohort study was conducted, including 62 patients undergoing penile surgery with SIS ( n = 31) or CF ( n = 31) grafts. Preoperative variables included age, diabetes mellitus (DM) status, penile curvature, erectile function, and penile length. Primary outcomes assessed were operative time, postoperative penile length, erectile function, complication rates, and patient‐reported satisfaction. All statistical analyses were conducted using IBM SPSS Statistics. Results The CF group had significantly shorter mean operative times (105±23 vs. 159±29 min, p < 0.001) and lower rates of penile hypoesthesia (12.9% vs. 45.2%, p = 0.005) and curvature recurrence (16.1% vs. 41.9%, p = 0.025). However, CF grafting was associated with higher postoperative pain (22.6% vs. 3.2%, p = 0.023). No significant differences were found in erectile function decline, penile length gain, or patient satisfaction. Discussion CF grafting offers shorter surgical time and reduced recurrence rates, whereas SIS grafting results in lower postoperative pain. Both techniques provide comparable penile length preservation and erectile function outcomes. Conclusion CF and SIS grafts are effective in PD surgery, with CF reducing operative time and complications but increasing pain. Personalized graft selection is essential for optimizing surgical outcomes and patient satisfaction.

Levomepromazine-induced priapism: a description of clinical cases

2025-06-20

Larissa Moraes Stefanini , Liara Ruiz Lima , Isabele Costa Cruz +2 more | MedNEXT Journal of Medical and Health Sciences

Introduction: Priapism is defined as a persistent and painful erection without sexual stimulation that lasts at least 4 hours. Although rare, it can be triggered by some factors such as … Introduction: Priapism is defined as a persistent and painful erection without sexual stimulation that lasts at least 4 hours. Although rare, it can be triggered by some factors such as hemoglobinopathies, paraneoplastic syndromes, and the use of recreational drugs and antipsychotics, with atypical and typical antipsychotics being responsible for half of the medication-induced priapisms. Objective: The present study aimed to record two clinical cases of priapism after the administration of a typical antipsychotic, levomepromazine, in two patients who were hospitalized in a psychiatric institution. It is important to recognize this manifestation to guide patients about prolonged and pathological erection, to prevent not only possible complications but also to ensure good medication adherence. Clinical cases: This study was analyzed and approved by the Research Ethics Committee according to a substantiated opinion number 6.949.882, and the patient's consent through the Informed Consent Form. Patient 1: Upon admission, he was prescribed thiamine, lorazepam, and levomepromazine. After eight days of regular use of the medication, he presented with prolonged (>4h) painful penile erection without the presence of sexual stimulation or excitement and was diagnosed with priapism. Patient 2: In the final phase of treatment, stable, when after withdrawal of benzodiazepines he presented with initial insomnia, it was decided to optimize the dose of levomepromazine (already being used) from 75 mg to 100 mg at night. One day later, he presented with priapism and was referred to the emergency room and administered local analgesia. Final considerations: Based on the two clinical case reports described, it is possible to infer that priapism was generated as a consequence of the use of levomepromazine, since this type of adverse reaction can already be expected, although not so frequently, from the use of antipsychotics based on the existing literature.

Sexual Dysfunction of Alcohol Dependent Individuals Presenting to Psychiatry Opd in a Tertiary Care Hospital

2025-06-20

Shruti Vishwakarma , Gautam Kumar , Ritika Jain +1 more | Journal of Pharmacy And Bioallied Sciences

A BSTRACT Background: Chronic alcohol consumption does not just undermine physical health it also quietly chips away at closeness and emotional connection. One of its most ignored results is sexual … A BSTRACT Background: Chronic alcohol consumption does not just undermine physical health it also quietly chips away at closeness and emotional connection. One of its most ignored results is sexual dysfunction. This study looked at how male sexual function is affected by alcohol consumption and how its severity affects the degree of impairment. Methods: A cross-sectional study of 162 alcohol-dependent men and 50 age-matched controls was conducted at the psychiatry OPD of a tertiary care hospital. Administered were validated instruments Alcohol Use Disorders Identification Test (AUDIT) for alcohol consumption severity, Premature Ejaculation Diagnostic Tool (PEDT) for ejaculation and International Index of Erectile Function (IIEF) for erectile and sexual domains. Results: Nearly 8 of 10 alcohol-dependent men (77.2%) reported some sort of sexual dysfunction, compared with 44.0% in controls ( P < 0.001). Of those, erectile dysfunction (63.0% vs. 18.0%) was the most prevalent, followed by decreased sexual desire (57.4% vs. 28.0%) and early ejaculation (46.3% vs. 28.0%). Significantly, more AUDIT scores were related to more dysfunction in all sexual domains. Conclusion: More drinking, less intimacy the link is obvious. Acknowledging and handling sexual health in these people could help not just their relationships but also their road to recovery.

Prevalence of Sexual Dysfunction with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): An Updated Systematic Review and Meta-Analysis

2025-06-19

Saad Alshahrani , Basem A. Fathi , Tamer A. Abouelgreed +1 more | Medicina

Background and Objectives: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition linked to substantial urogenital symptoms, notably sexual dysfunction. This meta-analysis sought to determine the overall prevalence of … Background and Objectives: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition linked to substantial urogenital symptoms, notably sexual dysfunction. This meta-analysis sought to determine the overall prevalence of sexual dysfunction in men with CP/CPPS, considering the four primary categories: desire, arousal, orgasm, and pain disorders. Materials and Methods: A systematic literature review, following MOOSE guidelines, was performed across four electronic databases (PubMed, Embase, Web of Science, and Google Scholar) for the period from January 2000 to 2025. The review included observational studies reporting the prevalence of sexual dysfunction in men with CP/CPPS. Data extraction and quality assessment were conducted independently by two reviewers. A random-effects model was used to calculate the pooled prevalence estimates and 95% confidence intervals. Heterogeneity was evaluated using I2, τ2, and Chi-squared tests, while publication bias was assessed via funnel plot asymmetry and Egger's test. Results: The meta-analysis incorporated data from 26 studies, representing a total of 20,127 participants. The pooled prevalence of overall sexual dysfunction was 59% (95% CI: 34-81%; I2 = 98%) across six studies and 5333 participants. Pooled erectile dysfunction (ED) prevalence was 34% (95% CI: 26-42%; I2 = 99%) across 24 studies with 20,127 participants, whereas pooled prevalence for premature ejaculation (PE) was 35% (95% CI: 22-49%; I2 = 98%) across 10 studies with 13,686 participants. Significant heterogeneity was observed across all analyses (I2 > 98%). Funnel plot analysis suggested potential asymmetry, but Egger's test was non-significant (p = 0.7034). Conclusions: This meta-analysis confirms the high prevalence of sexual dysfunction, including ED and PE, in men with CP/CPPS, providing a comprehensive estimate of its burden. The substantial heterogeneity observed underscores the need for further research to identify contributing factors and develop targeted interventions.

Prevalence of cardiac dysfunction in men with erectile dysfunction: the <scp>EDcard</scp> study

2025-06-19

Emil Durukan , Christian Fuglesang S. Jensen , Maria Dons +7 more | BJU International

Objectives To assess the prevalence of myocardial impairment in men with erectile dysfunction (ED) as compared with the general population using conventional and two‐dimensional speckle‐tracking echocardiography. Subjects and Methods In … Objectives To assess the prevalence of myocardial impairment in men with erectile dysfunction (ED) as compared with the general population using conventional and two‐dimensional speckle‐tracking echocardiography. Subjects and Methods In this cross‐sectional study, men with ED underwent clinical, electrocardiographic, and transthoracic echocardiographic evaluation including left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) according to a predefined protocol. All participants were matched 1:1 with controls from the general population on sex, age, and body mass index (BMI). Results In total, 796 people were included, 398 men with ED and 398 controls. The ED group had a median (interquartile range [IQR]) age of 61 (53–70) years and a median (IQR) BMI of 26.3 (24–29) kg/m 2 . Left ventricular (LV) systolic dysfunction was found in 232 (58.3%) men with ED compared to 102 (25.6%) controls ( P < 0.001). Nineteen (4.8%) men with ED were referred for further cardiovascular evaluation. Conclusion More than half of men with ED exhibited signs of cardiac dysfunction, particularly LV systolic dysfunction. Further research should explore the long‐term prognostic implications of these findings.

Perceptions and Practice of Urologists in Saudi Arabia Regarding Sexual Complications Related to LUTS/BPH Management

2025-06-19

Saad Alshahrani , Abdulrahman S Binsaleh , Ahmed Othman Alghamdi +3 more | Journal of Clinical Medicine

Objectives: This study aimed to evaluate perceptions and practices of urologists in Saudi Arabia regarding discussions of erectile dysfunction (ED) and ejaculatory dysfunction (EjD) with patients before initiating BPH treatments. … Objectives: This study aimed to evaluate perceptions and practices of urologists in Saudi Arabia regarding discussions of erectile dysfunction (ED) and ejaculatory dysfunction (EjD) with patients before initiating BPH treatments. Methods: A cross-sectional survey was conducted using a structured questionnaire distributed during the 36th Saudi Urological Annual Conference held in Riyadh in February 2025 among urologists in Saudi Arabia. A binary outcome variable, "frequent and open discussion," was created based on a scoring system using the median score of these responses. Data analysis included descriptive statistics and univariate (p < 0.25) and multivariate (p < 0.05) logistic regression using SPSS version 27. Results: Discussions about ED risks were most frequent before prescribing 5-alpha reductase inhibitors (5-ARIs) (51.3%) and combined alpha-blockers and 5-ARIs therapy (50.0%), whereas EjD risks were more frequently addressed before alpha-blocker monotherapy (59.2%) and transurethral resection of the prostate (TURP) (56.6%). A substantial proportion of urologists discussed alternative treatments based on sexual dysfunction risks, particularly before TURP (53.9%), alpha-blockers (47.4%), and 5-ARIs (43.4%). Univariate analysis revealed a trend towards more open discussions among non-Saudi urologists (OR 4.58, 95% CI 0.88-23.74, p = 0.06) and a significant association with working in private hospitals (OR 3.68, 95% CI 0.39-35.14, p = 0.03). However, these associations did not hold in multivariate analysis. Conclusions: Urologists in Saudi Arabia demonstrate variability in discussing sexual complications with patients before BPH treatments. Consistent and comprehensive discussions about ED and EjD risks are crucial for informed patient decision-making. Standardized guidelines and educational programs are needed to enhance urologists' communication skills and ensure consistent patient counseling.

Sexual dysfunction and other prolactin-related side effects of antipsychotic drugs in schizophrenia: Protocol for a systematic review with single-arm, pairwise, and network meta-analyses of randomized controlled trials and non-randomized studies

2025-06-19

Johannes Schneider‐Thoma , Shimeng Dong , David D. Kim +6 more | F1000Research

<ns3:p>Introduction Sexual dysfunctions are common yet underreported side effects of antipsychotics for schizophrenia, affecting 30-80% of treated individuals. These side effects can severely impact social interactions and treatment adherence for … <ns3:p>Introduction Sexual dysfunctions are common yet underreported side effects of antipsychotics for schizophrenia, affecting 30-80% of treated individuals. These side effects can severely impact social interactions and treatment adherence for individuals with schizophrenia, but comprehensive comparative evidence assessing the risk profiles of different antipsychotics is lacking. This study aims to address this gap using network meta-analysis that integrates data from both randomized-controlled trials (RCTs) and non-randomized studies (NRS). Protocol This systematic review will include both RCTs and NRS focusing on participants with schizophrenia or schizophrenia-like psychoses, without restrictions on symptoms, gender, ethnicity, age, or setting. For interventions, all second-generation antipsychotics will be included. The primary outcome will be the occurrence of at least one sexual adverse event of any kind. Secondary outcomes will be the occurrence of any sexual adverse event evaluated in men and women separately, and any adverse event related to the three phases of sexual response cycle separately: desire (e.g. libido, sexual thoughts), arousal (e.g. erection, lubrication) and orgasm (e.g. ejaculation, anorgasmia), and any adverse effect related to breast dysfunction and menstruation irregularities. Study selection and data extraction will be performed independently by two reviewers. The Cochrane Risk of Bias tool 1 and ROBINS-I will be employed to evaluate the risk of bias for RCTs and NRS, respectively. Single-arm meta-analysis of proportions will synthesize the average frequency of sexual adverse events in treated participants. Pairwise and network meta-analysis of RCTs and NRS will be used to evaluate comparative tolerability. Subgroup and sensitivity analyses will explore possible heterogeneity in results and validate the findings’ robustness. The quality of the evidence will be evaluated using GRADE. Discussion This study will provide vital insights into the sexual side effects of antipsychotics by combining evidence from clinical trials and real-world practice, facilitating better decision-making in choosing the optimal antipsychotic for individuals.</ns3:p>

Evaluation of magnetic stimulation as a non-invasive technique in treating different causes of erectile dysfunction: a prospective cohort study

2025-06-19

Hasan M. El‐Fakahany , Haythem Bassyouni. , Sameh Fayek GamalEl Din +1 more | Basic and Clinical Andrology

Abstract Background Elaboration of alternative therapeutic modality is needed, which should be safer, less costly and with no side effects. Functional Magnetic Stimulator (FMS) is a technique that was approved … Abstract Background Elaboration of alternative therapeutic modality is needed, which should be safer, less costly and with no side effects. Functional Magnetic Stimulator (FMS) is a technique that was approved by the US Food and Drug Administration in 1998. We aimed to evaluate the efficacy of FMS in treating different causes of erectile dysfunction (ED). Results The mean baseline 15 items of the international index of erectile function (IIEF-15) scores of groups A (arteriogenic ED), B (veno-occlusive ED) and C (psychogenic ED) were 12.8 ± 2.6, 16.2 ± 3.3 and 27.5 ± 3.7, respectively. The mean post sessions IIEF-15 scores of groups A, B and C were 23.4 ± 4.1, 31.5 ± 3.5, 49.2 ± 3.5, respectively. The mean baseline domains of erectile function (EF) scores of groups A, B and C were 3.8 ± 2, 5.8 ± 3.5 and 11.5 ± 3.1, respectively. The mean post sessions domains of EF scores of groups A, B and C were 10.6 ± 3.1, 15 ± 3.6 and 24.8 ± 2.9, respectively. The mean baseline domains of orgasmic function scores of groups A, B and C were 3.3 ± 0.9, 3.9 ± 0.5 and 4.8 ± 0.4, respectively. The mean post sessions domains of orgasmic function scores of groups A, B and C were 4.8 ± 0.8 5.9 ± 1.0 and 8.6 ± 0.5, respectively. The mean baseline domains of sexual desire scores of groups A, B and C were 2.6 ± 0.6, 3.1 ± 0.7 and 4.8 ± 0.7, respectively. The mean post sessions domains of sexual desire scores of groups A, B and C were 3.6 ± 0.5, 4.4 ± 0.7 and 6.6 ± 0.6, respectively. The mean baseline domains of intercourse satisfaction scores of groups A, B and C were 1.9 ± 0.5, 2.4 ± 0.6 and 4.1 ± 0.6, respectively. The mean post sessions domains of intercourse satisfaction scores of groups A, B and C were 2.6 ± 0.5, 3.6 ± 0.5 and 5.5 ± 0.6, respectively. The baseline domains of overall satisfaction scores of groups A, B and C were 1.1 ± 0.3, 1.1 ± 0.3 and 2.4 ± 0.7, respectively. The mean post sessions domains of overall satisfaction scores of groups A, B and C were 2 ± 0.7, 2.7 ± 0.7 and 3.8 ± 0.7, respectively. Conclusions All patients showed significant improvement regarding domains of the IIEF-15 especially psychogenic cases following the sessions of FMS. Future studies should demonstrate the impact of these sessions on the response of poor responders to phosphodiesterase inhibitors and intracorporeal injections.

Cavernosal aspiration for ischemic priapism: A stepwise procedural case report

2025-06-19

Emily R. Stack , Lawrence B. Stack | Visual Journal of Emergency Medicine

Penile sympathetic skin response in patients with non-organic erectile dysfunction: a Cross-Sectional Study

2025-06-18

Qingqiang Gao , Xuechao Han , You-Feng Han +4 more | International Journal of Impotence Research

This study evaluated the clinical value of penile sympathetic skin response (PSSR) in patients with non-organic erectile dysfunction (ED) and its correlation with psychological status. Based on the results of … This study evaluated the clinical value of penile sympathetic skin response (PSSR) in patients with non-organic erectile dysfunction (ED) and its correlation with psychological status. Based on the results of the nocturnal penile tumescence and rigidity (NPTR) test, the study included 68 patients with non-organic ED, 30 patients with organic ED, and 120 matched control subjects with normal erectile function. All subjects underwent PSSR testing to measure PSSR latency, International Index of Erectile Function-5 (IIEF-5) scores, and self-rating anxiety scale (SAS) scores. The results showed that the PSSR latency in patients with non-organic ED was significantly shorter than that in patients with organic ED and normal controls (NCs) (1179.12 ± 145.38 vs. 1420.00 ± 145.97 vs. 1382.00 ± 179.68 ms, p < 0.001). Furthermore, PSSR latency in patients with non-organic ED was negatively correlated with the SAS anxiety score (p < 0.001, r = -0.681) and positively correlated with the IIEF-5 score (p < 0.001, r = 0.493). Our study results suggest that patients with non-organic ED have excessive sympathetic excitation, and PSSR can be used as an objective electrophysiological indicator to assess autonomic nerve dysfunction, providing a rapid, non-invasive auxiliary tool for clinical differential diagnosis. This study is the first to reveal a significant association between PSSR latency and psychological anxiety, suggesting that enhanced sympathetic nerve activity may be an important pathological mechanism of non-organic ED.

The effect of ginseng on sexual function in postmenopausal women with major depression: a triple-blind randomized controlled trial

2025-06-18

Zahra Sharifpour , Shirin Hasanpoor , Sakineh Mohammad‐Alizadeh‐Charandabi +3 more | Journal of Pharmaceutical Health Care and Sciences

Abstract Background Women often experience a decline in sexual desire as they age, particularly during menopause. An increase in sexual dysfunction is associated with the worsening of genitourinary symptoms that … Abstract Background Women often experience a decline in sexual desire as they age, particularly during menopause. An increase in sexual dysfunction is associated with the worsening of genitourinary symptoms that occur with menopause. Anxiety, fear, and depression in postmenopausal women may further deteriorate sexual dysfunction. Utilizing modern and effective methods to enhance sexual desire in these women is a priority in midwifery care. Given previous studies, ginseng is a herbal medicine that may be suitable in this regard. This study aimed to determine the effect of ginseng on sexual function (primary outcome), menopause symptoms, depression symptoms and side events (secondary outcomes) in postmenopausal women with major depression. Methods This triple-blind randomized controlled trial was conducted on postmenopausal women with major depression in Tabriz, Iran between December 2022 and March 2024. A total of 66 postmenopausal women aged 45 to 60 with major depressive disorder were randomly assigned to intervention and control groups using block randomization. The intervention group received a 250-mg ginseng capsule twice daily after meals for eight weeks, while the control group received two gelatin placebo capsules (containing liquid edible paraffin) daily, similar in appearance to the ginseng capsules. Data collection was performed using the Female Sexual Function Index (FSFI), the Beck Depression Inventory (BDI), and the Greene Climactric Scale (GCS). The independent t-test and ANCOVA were used for data analysis. Results The two groups did not show statistically significant differences in terms of demographic and baseline outcome measures. After the intervention, the mean overall sexual function score in the ginseng group was significantly higher than in the control group (adjusted mean difference (AMD): 2.17; 95% confidence interval (95%CI): 1.32 to 3.03, P = 0.001). The mean overall menopause symptoms score (AMD: -3.61; 95% CI: -5.47 to -1.74, P < 0.001) and depression score (AMD: -3.96; 95% CI: -5.76 to -2.20, P < 0.001) were significantly lower in the ginseng group compared to the placebo group. Conclusion Ginseng is effective in improving sexual function and reducing menopause symptoms and depression in women with major depression. However, further research is needed to draw definitive conclusions. Trial registration Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N74. Date of registration: 10/12/2022; URL: https://irct.behdasht.gov.ir/user/trial/65711/view ; Date of first registration: 20/12/2022.

Biomimetic model to study penile dysfunctions

2025-06-17

Isabelle Martinier , Laetitia de Kort , Petra de Graaf | Nature Biomedical Engineering

An Experimental Investigation of Sexual Scripts by Partner Gender: Anticipated Clitoral Stimulation and Partner Orgasm Pursuit Shape Women’s Orgasm Expectations

2025-06-17

Grace M. Wetzel , Carly Wolfer , Cheryl L. Carmichael +1 more | Archives of Sexual Behavior

Genitourinary syndrome of menopause—it has only just begun!

2025-06-17

M. Richardson | Menopause The Journal of The North American Menopause Society

Will gut, oral, and vaginal microbiota influence the outcome of FET or be influenced by FET? A pilot study

2025-06-17

Zhao Zhang , Yiwen Zhang , Aihua Wu +2 more | mBio

ABSTRACT This study aims to examine the specific relationships between gut, oral, and vaginal microbiota and the frozen embryo transfer (FET) process. Patients undergoing fertility treatment who met the inclusion … ABSTRACT This study aims to examine the specific relationships between gut, oral, and vaginal microbiota and the frozen embryo transfer (FET) process. Patients undergoing fertility treatment who met the inclusion criteria were included in this study. After sampling at three time points, participants were then divided into two groups: the failure group and the success group, based on whether a viable intrauterine pregnancy was confirmed. In this pilot study, we systematically examined changes in the gut, oral, and vaginal microbiota at various stages of the FET process using 16S rDNA high-throughput sequencing and investigated their respective associations with FET outcomes. Metabolomics and random forest were used for evaluating the relationship between gut microbiota and metabolites during FET. Our findings indicate that while the gut microbiota underwent the least change throughout FET, it exhibited the greatest differences between success and failure groups. The oral and vaginal microbiota exhibited significant fluctuations. However, the differences in oral microbiota between the success and failure groups changed with the FET process, while the vaginal microbiota did not show any differences. Notably, two key gut genera, Anaerococcus and Negativicoccus , were identified as genera significantly associated with FET outcomes. Additionally, specific gut microbiota and metabolite profiles displayed significant correlations with FET success, particularly highlighting the potential relevance of cystamine before FET. These findings suggest that targeting microbiota-associated metabolic pathways may serve as a potential strategy to enhance FET success rates and provide new biomarkers for clinical prediction and intervention. IMPORTANCE This study explores the potential role of microbiota in influencing FET outcomes. Through an analysis of gut, oral, and vaginal microbiota, we observed notable differences between success and failure groups, particularly in gut microbiota. Genera such as Anaerococcus and Negativicoccus , along with associated metabolic profiles, may offer insights into underlying mechanisms. These findings contribute to a growing understanding of the interplay between microbiota and reproductive outcomes and suggest that targeting microbiota-associated metabolic pathways could be a promising direction for enhancing FET success rates. This research highlights potential biomarkers and therapeutic avenues for further exploration in fertility treatments.

The Impact of Diabetes on Erectile Dysfunction: Pathophysiology and Management Strategies

2025-06-17

Abdul Basit Niazi , Muhammad Asif Ammar , Muhammad Omer +3 more | Journal of Neonatal Surgery

Background:Having diabetes mellitus seriously increases the risk for erectile dysfunction (ED) in men. Locally raised blood sugar levels over a long period are responsible for losing nerve function in the … Background:Having diabetes mellitus seriously increases the risk for erectile dysfunction (ED) in men. Locally raised blood sugar levels over a long period are responsible for losing nerve function in the penis and hormone imbalance which eventually lead to ED. Analyzing this relationship helps doctors work better with diabetic patients. Objectives:We need to look at the rates, key functions behind and proven effects of current therapies for erectile dysfunction in men with diabetes. Study design: A prospective study. Place and duration of study: Department of Urology Niazi Medical College Sargodha from jan 2022 to jan 2023 Methods:The study used a prospective protocol to look at 100 men with diabetes who were experiencing ED in Department of Urology Niazi Medical College Sargodha from jan 2022 to jan 2023. During evaluation, a history was taken, a physical examination was carried out and tests for fasting glucose, HbA1c and serum testosterone were made. The performance of erectile function was evaluated using the IIEF questionnaire. All data analysis was performed in SPSS version 25 and only results with p<0.05 were considered significant. Results:100 patients whose average age was 54.2 years with a range of 9.1 years. Patients had been living with diabetes for about 8.5 years on average. Of those who took part, 72% had moderate or severe erectile dysfunction. Poor glycemic control (HbA1c level higher than 7.5%) was strongly related to the seriousness of ED (p=0.003). Severe ED was associated with lower testosterone levels (mean 280 ng/dL) compared to those with mild ED (mean 410 ng/dL), p=0.01. Conclusion:The risk of erectile dysfunction is much higher for diabetics, linked to less-than-ideal control of blood sugar and low testosterone. Right away, doctors should use a complete treatment plan that includes choosing the right dose of sugars, hormonal therapy and PDE5 inhibitors to improve both sex life and quality of life for men with diabetes..

Chlorpromazine-Tadalafil Interaction Leading to Refractory Ischemic Priapism and Penile Prosthesis Implantation

2025-06-16

Ceyhun Arıcı , Mert Başaranoğlu , Selahíttín Çayan +2 more | Research Square (Research Square)

<title>Abstract</title> Introduction: Priapism is a rare urological emergency characterized by a persistent, often painful penile erection unrelated to sexual stimulation. Antipsychotic medications, including chlorpromazine, are known to cause priapism through … <title>Abstract</title> Introduction: Priapism is a rare urological emergency characterized by a persistent, often painful penile erection unrelated to sexual stimulation. Antipsychotic medications, including chlorpromazine, are known to cause priapism through their alpha-adrenergic blocking properties. Case Presentation: We present the case of a 56-year-old male who developed refractory ischemic priapism following self-medication with oral chlorpromazine for hiccups after taking tadalafil 20 mg 24 hours prior for erectile dysfunction. This combination created a clinically significant drug interaction. The patient had experienced a brief priapism episode 10 years earlier following chlorpromazine use alone, establishing chlorpromazine as the primary causative agent. Despite systematic management with corporal aspiration, intracavernosal injection of sympathomimetics, and distal T-shunt, the patient experienced recurrent priapism necessitating penile prosthesis implantation. Discussion After thorough exclusion of alternative etiologies, this case provides compelling evidence for chlorpromazine as a causative agent of priapism, with the synergistic interaction with phosphodiesterase type 5 inhibitors exacerbating the condition to a severe, treatment-resistant state. Conclusion This report emphasizes the importance of recognizing this potentially dangerous drug interaction and provides specific clinical recommendations for prevention and management.

Risperidone-induced priapism in a middle-aged adult: Preventive considerations

2025-06-16

P N Suresh Kumar , Rohith Suresh , Vikas Menon | Asian Journal of Psychiatry

P56 Mental health impact in Peyronie’s Disease: The MIND-PD study

2025-06-16

M.M. Haslund , Elıf Durukan , Sandra Amalie Thy +7 more | European Urology Open Science

The hormonal regulation of men’s sexual desire, arousal, and penile erection: recommendations from the fifth international consultation on sexual medicine (ICSM 2024)

2025-06-16

Giulia Rastrelli , Leen Antonio , Serge Carrier +2 more | Sexual Medicine Reviews

The Role of the Gut Microbiome in CRPS

2025-06-16

| Topics in Pain Management

Evaluation of penile anatomy with MRI: a practical assessment of anatomical variations

2025-06-16

Caner Baran , Mehmet Gökhan Çulha , Kaya Aksoy +3 more | The Journal of Sexual Medicine

High social vulnerability impacts severity of erectile function at time of urologic referral

2025-06-16

David Y. Song , Carl Ceraolo , Soumya Konar +2 more | The Journal of Sexual Medicine

Factors affecting the success of corporoplasty based on geometric principles in patients with congenital penile curvature

2025-06-16

Mert Hamza Özbilen , Burak Sağmak , Mehmet Çağlar Çakıcı +7 more | The Journal of Sexual Medicine

P29 Approach to late-presenting priapism: Our clinical experiences

2025-06-16

Almina ARSLAN , Erdal Benli̇ , Ahmet Acet +2 more | European Urology Open Science

Identification of potential drug targets for erectile dysfunction with single‐cell RNA sequencing: A Mendelian randomization study

2025-06-15

Boyu Xiang , Jie Wen , Yu Wang +7 more | Andrology

Abstract Background A subset of patients with erectile dysfunction (ED) responds poorly to current pharmacological treatments, largely due to the limited availability of well‐defined therapeutic targets beyond phosphodiesterase 5 inhibitors … Abstract Background A subset of patients with erectile dysfunction (ED) responds poorly to current pharmacological treatments, largely due to the limited availability of well‐defined therapeutic targets beyond phosphodiesterase 5 inhibitors (PDE5i). Methods This study used Mendelian randomization (MR) to identify potential therapeutic targets for ED. Cis‐expression quantitative trait loci (cis‐eQTL) were sourced from the eQTLGen Consortium (31,684 individuals). ED summary statistics were derived from two cohorts (229,980 individuals: 6175 ED cases, 223,805 controls; 95,178 individuals: 1154 ED cases, 94,024 controls). Co‐localization analysis assessed shared single nucleotide polymorphism (SNP) influencing ED risk and gene expression. Drug prediction and molecular docking were utilized to validate the therapeutic potential of the identified drug targets, while single‐cell RNA sequencing (scRNA‐seq, dataset GSE206528) identified relevant cell types. Results Two drug targets demonstrated significance across both cohorts and were corroborated by co‐localization analysis. Phenome‐wide association studies (PheWAS) revealed no associations with other traits. Molecular docking analysis indicated strong binding affinities between the drugs and proteins. ScRNA‐seq results showed the target genes are predominantly expressed in endothelial cells (ECs), Schwann Cells (SWCs) and smooth muscle cells (SMCs). Conclusion This study highlights two promising ED targets, encouraging future research on ECs and SMCs to advance drug development and improve treatment outcomes.

The role of equity in partner contributions to sexual self-esteem for sexual health in romantic couples

2025-06-14

Fabienne S. V. Wehrli , Selina A. Landolt , Katharina Weitkamp +1 more | Journal of Social and Personal Relationships

Sexuality is central to well-being in many romantic relationships. Equity theory suggests that perceiving equal contributions within the relationship—presumably also within the sexual relationship—is associated with better outcomes, while a … Sexuality is central to well-being in many romantic relationships. Equity theory suggests that perceiving equal contributions within the relationship—presumably also within the sexual relationship—is associated with better outcomes, while a perceived imbalance may lead to distress or dissatisfaction. The current research examines whether equity of received and provided partner contributions to sexual self-esteem, as perceived by men and women, is associated with sexual satisfaction and sexual function for both partners. We conducted Dyadic Response Surface Analyses using data from 327 mixed-gender couples. Our results indicate that perceiving high, but not necessarily similar (i.e., equitable) levels of partner contributions to sexual self-esteem are associated with greater sexual satisfaction and function of both partners. When analyzing the subscales of partner contributions to sexual self-esteem, i.e. partner contributions to sexual self-worth and sexual self-efficacy, separately, we found a broad equity effect between received and provided sexual self-worth and sexual satisfaction for both partners. This means, that equality in received and provided sexual self-worth is associated with higher sexual satisfaction compared to when inequality is perceived. Additionally, perceived overbenefit in partner contributions to sexual self-efficacy in men was linked to lower sexual function in men. Our findings have implications for research and practice and suggest that gendered sexual scripts should be considered alongside equity theory when conducting research on sexual health in couples.

A Rare Presentation of Suicidality Following Penile Implant Surgery

2025-06-14

Shivananda Manohar , Karan Arora , Akshatha CJ | Journal of Psychosexual Health

Comparative Analysis of Local Versus General Anesthesia and Its Impact on Erectile Dysfunction Risk Following Penile Surgery

2025-06-13

Mary Harris , Shay Taylor , Elijah McMillan +7 more | Cureus

The impact of hypertension on sexual functions among women

2025-06-13

Maria Ciechacka , Agnieszka Pawełko , Ewelina Bąk | Journal of Education Health and Sport

Introduction. Human sexuality is an important factor in personality development. It is usually a positive driving force in the human population, motivating people to establish contacts and interpersonal bonds. The … Introduction. Human sexuality is an important factor in personality development. It is usually a positive driving force in the human population, motivating people to establish contacts and interpersonal bonds. The "gold standard" for screening tests for sexual disorders in women is currently the Female Sexual Function Index (FSFI). Particularly focusing on patients with hypertension can bring significant results. Material and methods The study was conducted among 106 women, including 48 diagnosed with hypertension and 58 without hypertension. The diagnostic survey method was used in this study. The study was conducted using the Female Sexual Function Index (FSFI) questionnaire. Results Hypertension has been shown to have a negative impact on all 6 domains of the FSFI and its overall score. The most negative feelings concern the arousal domain, and the least negative feelings concern the pain domain. Conclusions: Among patients with hypertension, there is a negative impact of this disease on sexual aspects. Patients with hypertension require greater focus on educational activities aimed at maintaining good blood pressure control, regular visits and compliance with therapeutic recommendations.

Sexual Dysfunction

2025-06-13

Adrian Perkel | Routledge eBooks

Penile prosthesis implantation: a systematic review of intraoperative and postoperative complications

2025-06-13

Andrea Cocci , Paolo Capogrosso , Suks Minhas +7 more | International Journal of Impotence Research

Evidence Supports Removing Restrictions on Mifepristone

2025-06-12

Daniel Grossman , Erica Chung | JAMA

This Viewpoint explores how a US Food and Drug Administration Risk Evaluation and Mitigation Strategy on mifepristone limited access to medication abortion despite its long-standing history of safety and efficacy. This Viewpoint explores how a US Food and Drug Administration Risk Evaluation and Mitigation Strategy on mifepristone limited access to medication abortion despite its long-standing history of safety and efficacy.

Critical Insights on “Patient Experiences and Expectations Regarding Erectile Dysfunction Education Prior to Rectal Cancer Surgery: A Qualitative Study”

2025-06-12

Bilal Ahmad , Noaman Khan , Abdur Rehman +2 more | Journal of Cancer Education