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Male Erectile Dysfunction (male + erectile_dysfunction)

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Medical Sciences	100%

Selected Abstracts

ORIGINAL RESEARCH,EPIDEMIOLOGY: Male Erectile Dysfunction: Its Prevalence in Western Australia and Associated Sociodemographic Factors

THE JOURNAL OF SEXUAL MEDICINE, Issue 1 2008
FRCPEdin, FRCPGlasg, Kew-Kim Chew MBBS
ABSTRACT Introduction., This is a report of a population-based cross-sectional observational study in Western Australia (WA) on male erectile dysfunction (ED). Aim., To assess the prevalence of ED in WA and to examine its associated sociodemographic factors. Method., Postal questionnaires were sent to randomly selected age-stratified male population samples obtained from the WA Electoral Roll. Main Outcome Measures., In addition to items covering sociodemographic and clinical information, the Australian Standard Classification of Occupations (ASCO), the Socioeconomic Index for Area (SEIFA), and the 5-item International Index of Erectile Function (IIEF-5) were used. Results., One thousand seven hundred seventy (41.9%) of 4,228 questionnaires were returned. One thousand five hundred eighty (89.3%) were completed questionnaires from men aged 20.1 to 99.6 years (mean 57.9, median 59.1, standard deviation 18.5). The prevalences of any ED and of severe ED among adult males in WA, adjusted for age distribution, were 25.1 and 8.5%, respectively. Standardized to World Health Organization (WHO) World Standard Population, the corresponding prevalences were 23.4 and 7.4%. Prevalence, as well as severity, of ED increased with age. Thirty-eight percent of the participants who were married or had partners experienced ED (severe ED 19.1%). The prevalence of ED was not significantly different between "white-collar" and "blue-collar" workers. Despite the great majority of the affected participants having experienced ED for >1 year, only 14.1% reported having ever received any treatment for ED. Conclusions., The study has provided population-based epidemiological data on ED in Western Australian men covering a wide range of ages. The finding that ED is age related, highly prevalent, and grossly underdiagnosed and undertreated is pertinent to global population aging and a rapidly aging Australian population. To facilitate comparisons across populations with different age distributions, all future population-based studies on ED should be standardized to WHO World Standard Population. Chew K-K, Stuckey B, Bremner A, Earle C, and Jamrozik K. Male Erectile Dysfunction: Its Prevalence in Western Australia and Associated Sociodemographic Factors. J Sex Med 2008;5:60,69. [source]

Sexual Dysfunction after Rectal Surgery: A Retrospective Study of Men without Disease Recurrence

THE JOURNAL OF SEXUAL MEDICINE, Issue 9 2010
Vahudin Zugor MD
ABSTRACT Introduction., Sexual dysfunction is a frequent complication of visceral surgery after rectal resections as a result of carcinoma of the rectum. Aim., The purpose of our study is to assess the incidence and form of sexual dysfunction in our own population of patients. Methods., The study comprised all patients who had undergone surgery for carcinoma of the rectum at the Erlangen Surgery University Hospital, Germany, in the period 2000,04. All male patients were retrospectively surveyed and asked to complete standardized (International Index of Erectile Function 15) questionnaires regarding their pre- and postsurgical sexual function. One hundred and forty-five questionnaires could be analyzed. The statistical evaluation was conducted with aid of the SPSS statistics program. The univariate analysis was carried out with the chi-square test and the U -test (Mann,Whitney Test). Main Outcome Measures., Erectile dysfunction, libido, and ability to have and sustain ejaculation and orgasm (both before and after surgery in each case) were among the dependent variables when compiling the data. The impact various surgical procedures and radiochemotherapy had on the severity of the sexual dysfunctions was analyzed. The scope of the postoperative urological care given was also assessed. Results., Erectile dysfunction was confirmed in N = 112 patients (77.3%) after surgery (P -value < 0.001). Other parameters such as orgasm capacity (4.1% vs. 16.5%), ejaculation ability (1.4% vs. 12.4%) and libido (3.4% vs. 22%) also showed a marked deterioration postoperatively. Postoperative erectile dysfunction was present in 77% of the patients with a colostomy and in 88.5% of the patients who had received neoadjuvant radiation. Conclusions., Male erectile dysfunction is a frequent complication after rectal resection as a result of carcinoma of the rectum. The high incidence of sexual dysfunctions results from the radical nature of the procedure and from additional radiation or colostomy therapy. These patients need accompanying urological care for treatment of their sexual dysfunction. Zugor V, Miskovic I, Lausen B, Matzel K, Hohenberger W, Schreiber M, Labanaris AP, Neuhuber W, Witt J, and Schott GE. Sexual dysfunction after rectal surgery: A retrospective study of men without disease recurrence. J Sex Med 2010;7:3199,3205. [source]

Penile pharmacotesting in diagnosing male erectile dysfunction: evidence for lack of accuracy and specificity

INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 1 2002
Antonio Aversa
Penile pharmacotesting (PPT) with alprostadil (PGE1) represents the most common diagnostic approach to male erectile dysfunction (ED). A positive response , i.e. normal erectile rigidity of sustained duration , is presumed to exclude venous or arterial pathology with enough accuracy. To test this assumption we compared PPT vs. flowmetric results obtained by colour-duplex Doppler ultrasound (CDDU) in patients (pts) undergoing diagnostic evaluation for ED under conditions of maximal cavernous relaxation. A total of 195 non-consecutive impotent pts were diagnosed after dynamic CDDU as non-vasculogenic (NOR), or having arteriogenic (AR), veno-occlusive (VO) or mixed (MX) ED. Maximal erection obtained after PPT was scored as: type-1 (full tumescence , no sustained rigidity, angle on the abdominal plane >90°), type-2 (sustained partial erection, valid for intromission, angle=90°) and type-3 (sustained full erection, angle <90°). Comparing PPT with flowmetric results, we found that a type-3 response had 20% false negative diagnosis of NOR (17% of AR- and 3% of VO- and MX-ED, respectively), while a type-2 response had 63% false negative diagnosis (20% of AR, 37% of VO- and 6% MX-ED, respectively). Type-1 response was associated with the presence of VO dysfunction in 99% of cases. These data suggest that a positive response to PPT (type-2 and type-3) assessed by the visual rating of erection is associated with both arterial (up to 20%) and/or VO (up to 43%) ED, as detected by CDDU. We conclude that PPT alone is a misleading diagnostic test to exclude vascular ED and that dynamic CDDU should be offered to pts investigated for male ED. [source]

New therapies for erectile dysfunction

INTERNATIONAL JOURNAL OF ANDROLOGY, Issue S2 2000
Hui-Meng Tan
The quest for improving and maintaining sexual function has been going on since time immemorial. The advent of an effective oral drug, sildenafil, has brought about unprecedented open discussion on male erectile dysfunction, and gas accelerated the pace of development of new therapies for erectile dysfunction. New knowledge in the physiology of sexual function has enabled researchers to target drug treatment at the whole network of the central nervous system and the numerous cascadic enzymatic reactions leading to relaxation of the corporal smooth muscle. One of the brightest potential applications of future molecular technology in the study of erectile dysfuction is in the utilization of gene therapy. [source]

Gene Transfer of TRPC6DN (Dominant Negative) Restores Erectile Function in Diabetic Rats

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010
Jae Hun Jung MD
ABSTRACT Introduction., Transient receptor potential (TRP) channels play an important role in modulating intracellular Ca2+ ([Ca2+]i) levels. Aim., We examined the hypothesis that overexpression of TRPC6DN (dominant negative) may contribute to decreased [Ca2+]i levels in corporal smooth muscle (CSM). We also investigated whether gene transfer of TRPC6DN could restore erectile function in diabetic rats. Methods., For the in vitro study, the KCa, KATP, and TRPC6DN channel genes were transferred using cDNA, into cultured human CSM cells and human embryonic kidney cells. For the in vivo study, young adult rats were divided into three groups: normal controls; diabetic controls transfected with vector only; and a diabetic group transfected with pcDNA of the TRPC6DN gene. Main Outcome Measures., After gene transfer, the effects of reducing [Ca2+]i levels were assessed by Fura-2-based imaging analysis. The intracavernosal pressure (ICP) response to cavernosal nerve stimulation was assessed after intracorporal injection of TRPC6DN pcDNA. The transgene expression of the TRPC6DN was examined by reverse transcription polymerase chain reaction (RT-PCR) in rats transfected with TRPC6DN pcDNA. Results., Gene transfer of ion channels effectively reduced [Ca2+]i. Among these channels, transfer of the TRPC6DN gene resulted in the greatest reduction of [Ca2+]i in human CSM. The mean (±standard error of the mean) ratio of ICP to mean arterial pressure (BP) in the gene-transfer rats was 79.4 ± 2.4% (N = 8). This was significantly higher than that in control rats (55.6 ± 3.7% [N = 8]), and similar to that in the young control rats (83 ± 2.2% [N = 12]). The RT-PCR showed expression of TRPC6DN genes in the transfected rats. Conclusion., Gene transfer of TRPC6DN not only reduced [Ca2+]i in human CSM but also restored erectile function in diabetic rats. These results suggest that pcDNA transfer of TRPC6DN may represent a promising new form of therapy for the treatment of male erectile dysfunction in the future. Jung JH, Kim BJ, Chae MR, Kam SC, Jeon J-H, So I, Chung KH, and Lee SW. Gene transfer of TRPC6DN (dominant negative) restores erectile function in diabetic rats. J Sex Med 2010;7:1126,1138. [source]

Internet-Based Brief Sex Therapy for Heterosexual Men with Sexual Dysfunctions: A Randomized Controlled Pilot Trial

THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2009
Jacques J.D.M. Van Lankveld PhD
ABSTRACT Introduction., Internet-based sex therapy for men with erectile dysfunction has been advocated as an easily accessible and cost-effective treatment. Aim., To test whether Internet-based sex therapy is superior to waiting list. Methods., Internet-based therapy was administered to heterosexual men with erectile dysfunction or premature ejaculation, without face-to-face contact, in a waiting-list controlled design, with pre-, post-, and follow-up measurements at 3 and 6 months posttreatment. Treatment was based on the sensate-focus model of Masters and Johnson, and supplemented with cognitive restructuring techniques. Main Outcome Measures., Self-reported improvement of sexual functioning, erectile functioning (men with ED), premature ejaculation (men with PE), sexual desire, overall sexual satisfaction, and sexual self-confidence. Results., Ninety-eight men participated (58 ED, 40 PE). Sexual functioning was much or somewhat improved in 40 participants (48%). In participants with ED, a near significant effect of treatment was found (P = 0.065), with higher levels of sexual desire (P < 0.05) and sexual self-confidence (P = 0.05) in treated men, in addition to improved erectile functioning (P = 0.01) and overall sexual satisfaction (P < 0.001) in both groups. In participants with PE, treatment was not superior to waiting list. In participants with ED, erectile functioning (P < 0.05) and overall sexual satisfaction (P = 0.002) improved significantly. In participants with PE, latency to ejaculation (P < 0.001), sexual desire (P < 0.05), and overall sexual satisfaction (P < 0.05) improved significantly from baseline to posttreatment, with no further changes at both follow-ups. Sexual self-confidence in men with PE remained unchanged during treatment until follow-up at 3 months posttreatment, and then was found to be improved at 6-months follow-up (P < 0.05). Conclusion., Internet-based sex therapy for male erectile dysfunction was efficacious for male erectile disorder. For men with premature ejaculation, however, treatment was not superior to waiting list. van Lankveld JJDM, Leusink P, van Diest S, Gijs L, and Slob AK. Internet-based brief sex therapy for heterosexual men with sexual dysfunctions: A randomized controlled pilot trial. J Sex Med 2009;6:2224,2236. [source]

Pharmacological and Functional Characterization of Novel EP and DP Receptor Agonists: DP1 Receptor Mediates Penile Erection in Multiple Species

THE JOURNAL OF SEXUAL MEDICINE, Issue 2 2008
Nadia Brugger PhD
ABSTRACT Introduction., Despite the widespread use of prostaglandin E1 as an efficacious treatment for male erectile dysfunction for more than two decades, research on prostanoid function in penile physiology has been limited. Aim., To characterize the pharmacological and physiological activity of novel subtype-selective EP and DP receptor agonists. Methods., Radioligand binding and second messenger assays were used to define receptor subtype specificity of the EP and DP agonists. Functional activity was further characterized using isolated human and rabbit penile cavernosal tissue in organ baths. In vivo activity was assessed in rabbits and rats by measuring changes in cavernous pressure after intracavernosal injection of receptor agonists. Main Outcome Measures., Receptor binding and signal transduction, smooth muscle contractile activity, erectile function. Results., In organ bath preparations of human cavernosal tissue contracted with phenylephrine, EP2- and EP4-selective agonists exhibited variable potency in causing relaxation. One of the compounds caused mild contraction, and none of the compounds was as effective as PGE1 (EC50 = 0.23 µM). There was no consistent correlation between the pharmacological profile (receptor binding and second messenger assays) of the EP agonists and their effect on cavernosal tissue tone. In contrast, the DP1-selective agonist AS702224 (EC50 =29 nM) was more effective in relaxing human cavernosal tissue than either PGE1, PGD2 (EC50 = 58 nM), or the DP agonist BW245C (EC50 =59 nM). In rabbit cavernosal tissue, PGE1 and PGD2 caused only contraction, while AS702224 and BW245C caused relaxation. Intracavernosal administration of AS702224 and BW245C also caused penile tumescence in rabbits and rats. For each compound, the erectile response improved with increasing dose and was significantly higher than vehicle alone. Conclusions., These data suggest that AS702224 is a potent DP1-selective agonist that causes penile erection. The DP1 receptor mediates relaxation in human cavernosal tissue, and stimulates pro-erectile responses in rat and rabbit. Thus, rabbits and rats can be useful models for investigating the physiological function of DP1 receptors. Brugger N, Kim NN, Araldi GL, Traish AM, and Palmer SS. Pharmacological and functional characterization of novel EP and DP receptor agonists: DP1 receptor mediates penile erection in multiple species. J Sex Med 2008;5:344,356. [source]

ORIGINAL RESEARCH,EPIDEMIOLOGY: Male Erectile Dysfunction: Its Prevalence in Western Australia and Associated Sociodemographic Factors

Expression of Messenger Ribonucleic Acid Encoding for Phosphodiesterase Isoenzymes in Human Female Genital Tissues

THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2007
Stefan Uckert PhD
ABSTRACT Objectives., The use of inhibitors of phosphodiesterase 5 (PDE5) has been suggested to treat symptoms of female sexual dysfunction (FSD). Nonetheless, there has been a relatively low success rate of PDE5 inhibitors in FSD in comparison with male erectile dysfunction. The elevated expression of PDE5 in the human penile erectile tissue is considered the reason for the high clinical efficacy of PDE5 inhibitors in the pharmacotherapy of male erectile dysfunction. Aim., To evaluate by means of molecular biology the expression of messenger ribonucleic acid expression (mRNA) encoding for cyclic AMP and cyclic GMP PDE isoenzymes in female genital tissues. Main Outcome Measures., The amount of mRNA transcripts specifically encoding for cyclic AMP- and/or cyclic GMP-degrading PDE isoenzymes was determined. Methods., Human clitoral, labial, and vaginal tissue was obtained from four female cadavers (age at death: 18,42 years). The expression of mRNA specifically encoding for PDE1A, 1B, 1C, 2A, 4A, 5A, 10A, and 11A was elucidated by means of real-time polymerase chain reaction (PCR) analysis (TaqMan). Human penile erectile tissue (corpus cavernosum [HCC]) was used as a reference tissue. Results., mRNA encoding for all PDE isoforms mentioned above is expressed in the female genital tissues. Different magnitudes of mRNA expression were observed: a predominant expression of mRNA encoding for PDE1A but only insignificant amounts of PDE1B, 1C, 4A, 10, and 11A mRNA were registered. With PDE1A being the only exception, the mRNA expression was always higher in the HCC than in the female genital tissues. Especially, the expression of mRNA encoding for PDE5 was several-fold higher in the HCC. Conclusion., On the mRNA level, various PDE isoforms are expressed in the clitoris, labia, and vagina. It remains to be established as to whether the low expression of PDE5 in female genital tissue might be a negative predictor for the success of PDE5 inhibitors in the treatment of FSD. Uckert S, Ellinghaus P, Albrecht K, Jonas U, and Oelke M. Expression of messenger ribonucleic acid encoding for phosphodiesterase isoenzymes in human female genital tissues. J Sex Med 2007;4:1604,1609. [source]

Retinal vascular findings and penile cavernosal artery blood flow

BJU INTERNATIONAL, Issue 9 2003
Y. Kawanishi
Authors from Japan attempt to correlate retinal vascular changes with cavernosal arterial blood flow. They studied patients with erectile dysfunction, but excluded patients with previous pelvic surgery, pelvic injury or diabetes. They found that penile changes can be anticipated from retinal vascular changes seen on fundoscopy. OBJECTIVE To assess the correlation between retinal vascular findings and penile cavernosal arterial blood flow, as it is probable that systemic atherosclerotic vascular disease is important in male erectile dysfunction (ED), and being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. PATIENTS AND METHODS The study included 75 patients with ED; any with a history of pelvic injury, pelvic surgery, or diabetes mellitus were excluded. All patients gave fully informed consent. Ocular fundus photographs were taken with an automatic-focus fundus camera under amydriatic conditions. Three ophthalmologists, unaware of the patients' detailed data, evaluated the photographs using Hyman's classification to evaluate retinal vascular findings. Blood flow in the penile cavernosal artery was measured with colour Doppler ultrasonography, and the peak systolic velocity used as a haemodynamic variable. Correlations among the peak systolic velocity, retinal vascular findings and vascular risk factors (including hypertension, age, cigarette smoking, and hyperlipidaemia) were investigated using multivariate analysis. RESULTS Of the 75 patients, 72 (96%) had both right and left retinal vascular images of sufficient quality for evaluation; 37 were classified as normal and 35 as Grade I, while no patient was Grade II. From a logistic regression multivariate analysis, the peak systolic velocity was the only significant factor correlating with retinal vascular findings, with an odds ratio of 3.34. In contrast, hypertension, age, cigarette smoking and hyperlipidaemia did not correlate significantly with the retinal vascular findings. Similarly, the retinal vascular finding was the only significant factor correlating with the peak systolic velocity of cavernosal blood flow (odds ratio 3.28) and again hypertension, age, cigarette smoking and hyperlipidaemia were not significant factors. CONCLUSIONS These findings support the assumption that penile erectile function is one of the diseases of atherosclerosis, and emerges nearly simultaneously with retinal vascular disease. It is possible to predict penile arterial conditions in patients with ED from their retinal vascular findings. Thus, amydriatic fundoscopy, a simple practical examination, may be helpful for primary physicians in diagnosing and treating ED. [source]

Pathophysiology and diagnosis of male erectile dysfunction

BJU INTERNATIONAL, Issue 2001
G. Wagner
First page of article [source]

Sildenafil reduces alcohol-induced gastric damage: just say ,NO'

BRITISH JOURNAL OF PHARMACOLOGY, Issue 4 2008
R Duffin
Although sildenafil (Viagra) and other phosphodiesterase V (PDE V) inhibitors are increasingly recognized for their use in the treatment of male erectile dysfunction and perhaps more recently pulmonary artery hypertension, less is known of their potential beneficial effects in other situations. Medeiros et al., in the current issue of the British Journal of Pharmacology, report that sildenafil dramatically reduces alcohol-induced gastric damage in rats. The authors provide convincing evidence that such protection not only occurs via the nitric oxide (NO)/cGMP pathway, but also involves regulation of ATP-sensitive potassium channels. Therefore, in addition to exerting anti-impotence efficacy, PDE V inhibitors may provide significant beneficial effects from mucosal injury induced by alcohol. British Journal of Pharmacology (2008) 153, 623,624; doi:10.1038/sj.bjp.0707642; published online 17 December 2007 [source]

In vitro models: research in physiology and pharmacology of the lower urinary tract

BRITISH JOURNAL OF PHARMACOLOGY, Issue S2 2006
Robert B. Moreland
The physiology and pharmacology of the lower urinary tract has advanced based, in part, due to the in vitro assays that have facilitated this exploration. Such assays have led to the development of novel and selective molecules that have been used to characterize different receptor and enzyme systems in the larger context of in vivo pharmacology. These assays can be classified by sites of action of drugs into the following categories: receptors, effector enzymes and enzymes that terminate the responses. In this review, representative assays are presented based on our experience in male erectile dysfunction. British Journal of Pharmacology (2006) 147, S56,S61. doi:10.1038/sj.bjp.0706505 [source]

Animal models in urological disease and sexual dysfunction

BRITISH JOURNAL OF PHARMACOLOGY, Issue S2 2006
Gordon McMurray
There are several conditions associated with dysfunction of the lower urinary tract or which result in a reduction in the ability to engage in satisfactory sexual function and result in significant bother to sufferers, partners and/or carers. This review describes some of the animal models that may be used to discover safe and effective medicines with which to treat them. While alpha adrenoceptor antagonists and 5-alpha-reductase inhibitors deliver improvement in symptom relief in benign prostatic hyperplasia sufferers, the availability of efficacious and well-tolerated medicines to treat incontinence is less well served. Stress urinary incontinence (SUI) has no approved medical therapy in the United States and overactive bladder (OAB) therapy is limited to treatment with muscarinic antagonists (anti-muscarinics). SUI and OAB are characterised by high prevalence, a growing ageing population and a strong desire from sufferers and physicians for more effective treatment options. High patient numbers with low presentation rates characterizes sexual dysfunction in men and women. The introduction of ViagraÔ in 1998 for treating male erectile dysfunction and the success of the phosphodiesterase type 5 inhibitor class (PDE5 inhibitor) have indicated the willingness of sufferers to seek treatment when an effective alternative to injections and devices is available. The main value of preclinical models in discovering new medicines is to predict clinical outcomes. This translation can be established relatively easily in areas of medicine where there are a large number of drugs with different underlying pharmacological mechanisms in clinical usage. However, apart from, for example, the use of PDE5 inhibitors to treat male erectile dysfunction and the use of anti-muscarinics to treat OAB, this clinical information is limited. Therefore, current confidence in existing preclinical models is based on our understanding of the biochemical, physiological, pathophysiological and psychological mechanisms underlying the conditions in humans and how they are reflected in preclinical models. Confidence in both the models used and the pharmacological data generated is reinforced if different models of related aspects of the same disorder generate confirmatory data. However, these models will only be fully validated in retrospect once the pharmacological agents they have helped identify are tested in humans. British Journal of Pharmacology (2006) 147, S62,S79. doi:10.1038/sj.bjp.0706630 [source]

Myocardial infarction following the combined recreational use of viagra® and cannabis

CLINICAL CARDIOLOGY, Issue 3 2002
Dr. A. L. McLeod M.D.
Abstract Sildenafil citrate (Viagra®,Pfizer, Inc., New York, N.Y.) is widely prescribed as a treatment for male erectile dysfunction. It is metabolized predominantly by the cytochrome P450 3A4 hepatic microsomal isoenzyme and effects can, therefore, be potentiated by such inhibitors. The vasodilatory effects of Viagra necessitate caution in its use in patients with cardiovascular disease and it is contraindicated in patients receiving nitrates. Previous literature has drawn attention to Viagra use and myocardial infarction. This paper reports the case of a young man who presented with a myocardial infarction after taking Viagra in combination with cannabis, a known inhibitor of the cytochrome P450 3A4 isoenzyme. [source]