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Erectile Function (erectile + function)

Distribution by Scientific Domains
Medical Sciences98%
Distribution within Medical Sciences
Urology17%
Andrology7%

Kinds of Erectile Function

  • normal erectile function
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    Terms modified by Erectile Function

  • erectile function domain
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  • erectile function questionnaire
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  • erectile function recovery
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    Selected Abstracts

    ERECTILE FUNCTION, SEXUAL DRIVE, AND EJACULATORY FUNCTION ALTER RECONSTRUCTIVE SURGERY FOR ANTERIOR URETHRAL STRICTURE DISEASE

    BJU INTERNATIONAL, Issue 6 2007
    Javier Ponce De León
    No abstract is available for this article. [source]

    Pergolide mesylate can improve sexual dysfunction in patients with Parkinson's disease: the results of an open, prospective, 6-month follow-up

    EUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2004
    M. Pohanka
    One of the most disabling problems in males suffering from advanced Parkinson's disease (PD) is complex sexual dysfunction. The effect of dopamine replacement or dopaminergic stimulation on sexual dysfunction has been recently examined and described in patients treated by L-DOPA or apomorphine. Pergolide mesylate is another dopamine agonist with a known high affinity to hD(2S) subtype and a lower affinity to hD(2L) subtype of D2 dopaminergic receptors. It has been repeatedly shown to be a highly effective treatment of the complicated and advanced stages of PD. The current study has been designed to assess its efficacy in the treatment of sexual dysfunction, which frequently accompanies the complicated stage of PD in males. Fourteen male patients suffering from PD, each of whom had been treated with L-DOPA, and in whom additional treatment with peroral dopaminergic agonist (DA) was needed, were followed for a 6-month period. Pergolide mesylate (Permax) was given to each patient, and titrated to a total daily dose of 3 mg. All of the patients were taking L-DOPA. The assessments performed before the start of pergolide treatment consisted of a neurological examination, including Unified Parkinson's Disease Rating Scale (UPDRS) III and IV subscales scoring, Mini Mental State Examination (MMSE) scoring, the neuropsychological examination including Zung scale scoring to exclude depression, biochemical and haematological examinations including the examination of prolactine serum levels; and a sexological examination during which the patients filled-in the International Index of Erectile Function (IIEF) questionnaire. These examinations were repeated during the control assessments at months 1, 3 and 6. To compare the examination results, anova, Friedmann's anova (non-parametric) and Tukey post hoc tests were used. There were statistically significant differences between the values of UPDRS III motor subscale, UPDRS IV (complications of therapy) subscale and all subscales of IIEF when months 0 and 1 were compared with the results obtained at months 3 and 6. The differences between months 0 and 1 and months 3 and 6 (in these items) were virtually insignificant. In conclusion, pergolide substantially improved sexual function in the younger male patients who were still interested in sexual activities. In such cases, the introduction of pergolide might be a better choice than treatment with sildenafile, which usually meets several contraindications in common PD male population. [source]

    Improvement in duration of erection following phosphodiesterase type 5 inhibitor therapy with vardenafil in men with erectile dysfunction: the ENDURANCE study

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2009
    M. T. Rosenberg
    Summary Objective:, The ENDURANCE study evaluated the efficacy of vardenafil, a phosphodiesterase type 5 (PDE5) inhibitor, in men with erectile dysfunction (ED), by measuring the duration of erection leading to successful intercourse using a stopwatch as the assessment instrument. Methods:, This was a randomised, multicentre, double-blind, placebo-controlled, crossover study consisting of a 4-week treatment-free run-in phase after which patients were randomised to either fixed-dose vardenafil 10 mg or placebo (to be administered 60 min prior to intercourse) and entered the first of the two 4-week double-blind treatment periods, separated by a 1-week washout. The primary efficacy end-point was the stopwatch-assessed duration of erection, which was defined as the time from erection perceived hard enough for penetration until withdrawal from the partner's vagina leading to successful intercourse as measured by Sexual Encounter Profile Question 3 (SEP-3). Secondary efficacy end-points included SEP-2 and SEP-3 success rates, the erectile function domain of the International Index of Erectile Function, global assessment questionnaire, change from baseline in duration of erection and duration of erection not leading to successful intercourse. Safety was assessed by adverse events (AEs), laboratory samples, vital signs and ECGs. Results:, Of the 191 men included in the safety population, 40% had moderate ED and 33% had severe ED at baseline. The duration of erection (least squares mean ± SE) leading to successful intercourse was longer with vardenafil than with placebo (12.81 ± 1.00 min vs. 5.45 ± 1.00 min; p < 0.001). The differences recorded for all secondary end-points were statistically significant in favour of vardenafil compared with placebo (p < 0.001), with the exception of duration of erection not leading to successful intercourse. Vardenafil was well tolerated in this study; the majority of AEs being mild-to-moderate in intensity. Conclusion:, Vardenafil 10-mg therapy provided a statistically superior duration of erection leading to successful intercourse in men with ED compared with placebo. [source]

    Effect of enhanced external counterpulsation on medically refractory angina patients with erectile dysfunction

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2007
    W. E. Lawson
    Summary Patients with refractory angina often suffer from erectile dysfunction. Enhanced external counterpulsation (EECP) decreases symptoms of angina, and increases nitric oxide release. This study evaluated the effect of EECP on sexual function in men with severe angina. The International Index of Erectile Function (IIEF) was used to assess erectile function of severe angina patients enroled in the International EECP Patient Registry. Their symptom status, medication use, adverse clinical events and quality of life were also recorded before and after completing a course of EECP. A cohort of 120 men (mean age 65.0 ± 9.7) was enroled. The men had severe coronary disease with 69% having a prior myocardial infarction, 90% prior coronary artery bypass graft or percutaneous coronary intervention, 49% with three vessel coronary artery disease, 86% were not candidates for further revascularisation, 71% hypertensive, 83% dyslipidaemia, 42% diabetes mellitus, 75% smoking and 68% using nitrates. Functional status was low with a mean Duke Activity Status Inventory score of 16.6 ± 14.8. After 35 h of EECP anginal status improved in 89%, and functional status in 63%. A comparison of the IIEF scores pre- and post-EECP therapy demonstrated a significant improvement in erectile function from 10.0 ± 1.0 to 11.8 ± 1.0 (p = 0.003), intercourse satisfaction (4.2 ± 0.5 to 5.0 ± 0.5, p = 0.009) and overall satisfaction (4.7 ± 0.3 to 5.3 ± 0.3, p = 0.001). However, there were no significant changes in orgasmic function (4.2 ± 0.4 to 4.6 ± 0.4, p = 0.19) or sexual desire (5.3 ± 0.2 to 5.5 ± 0.2). The findings suggest that EECP therapy is associated with improvement in erectile function in men with refractory angina. [source]

    Efficacy and safety of on-demand tadalafil for the treatment of erectile dysfunction in South-East Asian men

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006
    YING LU GUO
    Aim:, Tadalafil is an inhibitor of phosphodiesterase type 5 used for the treatment of erectile dysfunction (ED). The efficacy and safety of tadalafil have been evaluated extensively in Western populations. Our aim was to assess the efficacy and safety of on-demand tadalafil for the treatment of ED in South-East Asian men. Methods:, This was a randomized, double-blind, placebo-controlled study of men with mild to severe ED of various etiologies randomized to receive placebo (n = 122), tadalafil 10 mg (n = 120), or tadalafil 20 mg (n = 125), taken as needed (maximum once daily) for 12 weeks. Efficacy assessments included the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary, and a Global Assessment Question (GAQ). Results:, Men from China, Singapore, and the Philippines participated in this trial (n = 367). Compared with placebo, tadalafil significantly improved erectile dysfunction on all efficacy outcomes (P < 0.001). Patients receiving tadalafil 10 mg and 20 mg experienced a significant mean improvement of 8.1 and 8.7, respectively, in the IIEF Erectile Function (IIEF-EF) domain score from baseline (vs placebo 2.4, P < 0.001). In patients receiving tadalafil 10 mg and 20 mg, the mean per-patient success rate for intercourse attempts (SEP3) was 62% and 70%, respectively, compared with 32% for the placebo group (P < 0.001). Of patients who received tadalafil 10 mg and 20 mg, 81% and 86% reported improved erections at endpoint (GAQ) compared with 44% in the placebo group (P < 0.001). The most common adverse events reported by patients were headache, back pain, dyspepsia, and dizziness. Conclusions:, Tadalafil was an effective and well-tolerated treatment for South-East Asian men with ED. [source]

    Prevalence of erectile dysfunction in patients with metabolic syndrome

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2006
    TEVFIK DEMIR
    Aim:, We wished to investigate the relationship between metabolic syndrome and erectile dysfunction (ED). Materials and methods:, A total of 268 patients were included in this study. All of the patients were asked to fill in an International Index for Erectile Function (IIEF) questionnaire. The presence of metabolic syndrome was determined when any three or more of the five risk factors were present according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP)-III. The relationship between risk factor for metabolic syndrome and ED status was determined according to logistic regression analysis. Results:, Eighty-nine patients (33%) constituted the metabolic syndrome group. IIEF-EF domain scores of patients with and without metabolic syndrome were 17.7 ± 7.9 and 21.7 ± 7.5, respectively (P < 0.001). Seventy-four percent of patients with metabolic syndrome and 50% of patients without metabolic syndrome had ED (P < 0.001; odds ratio 2.9; 95% CI 1.7,5.0). Erectile function domain scores significantly decreased as the number of metabolic risk factors increased (P < 0.001). Patients with the risk factor of fasting blood glucose (FBG), waist circumference (WC), or hypertension (HT) had lower erectile function domain scores than the patients with other metabolic risk factors. Logistic regression analysis revealed that FBG and WC were the most important criteria for ED. Conclusions:, Metabolic syndrome seems to be a potential risk factor for ED. We recommend patients with metabolic syndrome should be questioned about ED, and WC measurement might take part in the evaluation of ED. [source]

    Preoperative erectile function is one predictor for post prostatectomy incontinence,

    NEUROUROLOGY AND URODYNAMICS, Issue 1 2007
    S. Wille
    Abstract Aims The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI. Patients and Methods Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively. Results Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P,=,0.024), whereas age (P,=,0.759) and nerve sparing prostatectomy (P,=,0.504) did not predict PPI. Conclusion Erectile function is a predictor of PPI and should be recorded preoperatively. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

    Sexual function, depressive symptoms and marital status in nonseminoma testicular cancer patients: a longitudinal study

    PSYCHO-ONCOLOGY, Issue 3 2010
    Marrit A. Tuinman
    Abstract Goal: To longitudinally investigate sexual functioning in testicular cancer patients during the first year, and examine the effect of relationship status (with a partner or single) and depressive symptoms on sexual functioning. Patients and methods: 93 testicular cancer patients (39% single) treated in two large referral centers for testicular cancer filled in the International Index of Erectile Function (IIEF) and CES-D after orchiectomy (T1) and 3 (T2) and 12 (T3) months later. Results: Orgasmic functioning, overall satisfaction and total sexual functioning decreased between T1 and T2 and increased to an above T1 level at T3. Levels of erectile functioning and intercourse satisfaction were higher at T3 than at T1 and T2. Desire remained stable. Type of treatment did not affect sexual functioning. Singles reported worse sexual functioning at all measurement times than committed patients, and comparable desire. One year after surgery, singles also reported worse sexual functioning on three domains when compared with norms. Depressive symptoms were highest and significantly but weakly related to one domain of sexual functioning at T1, to three domains at T2, and to none at T3. Early depressive symptoms had small to moderate predictive power on sexual functioning at T2, but not at T3. Conclusion: Sexual functioning, but not desire, fluctuates during the first year after testicular cancer. Type of treatment and depressive symptoms were no risk factors for sexual dysfunction in the longer term. Singles reported more sexual problems than patients in a relationship and norms, they may need more information and guidance concerning their sexuality. Copyright © 2009 John Wiley & Sons, Ltd. [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]

    Efficacy and Safety of Tadalafil 20 mg on Demand vs.

    THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2010
    Tadalafil 5 mg Once-a-Day in the Treatment of Post-Radiotherapy Erectile Dysfunction in Prostate Cancer Men: A Randomized Phase II Trial
    ABSTRACT Introduction., The role of phosphodiesterase type 5 inhibitors in the treatment of post-radiotherapy erectile dysfunction (ED) has not been extensively investigated. Aim., To compare the efficacy and safety of on-demand 20-mg tadalafil (arm A) with the newly released tadalafil 5-mg once-a-day dosing (arm B) in patients with ED following radiotherapy for prostate cancer (PC). Methods., Randomized study to receive on-demand 20-mg or once-a-day 5-mg tadalafil for 12 weeks. Main Outcome Measures., Changes in the International Index of Erectile Function (IIEF) domain scores and Sexual Encounter Profile (SEP) question 2 and 3 positive response rates. Results., Fifty-two out of 86 screened patients were randomized. Forty-four patients were evaluable for efficacy. A significant improvement in all domains of the IIEF was observed in both arms (P = 0.0001) with mean erectile function domain scores values of 25 and 27.1 for the 20-mg and 5-mg tadalafil, respectively (P = 0.19). SEP 2 and 3 positive response rates increased from 0% in both arms at baseline to 81% and 70% in the 20-mg arm and 90% and 73% in the 5-mg arm, respectively, at the end of treatment (P = 0.27). End of treatment global efficacy question positive answers were 86% in the 20-mg arm and 95% in the 5-mg arm (P = 0.27). Higher treatment compliance was shown in arm B (100%) as compared with arm A (86%). There was a nonstatistically significant trend toward fewer side effects in favor of the 5-mg daily dose arm. Conclusions., In the study population, both tadalafil formulations generated significantly high response rates according to the outcome measures and were well tolerated. The once-a-day 5-mg dosing showed higher compliance and marginally reduced side effects, thus making it an attractive alternative to on-demand therapy for ED in post-radiotherapy PC patients. Ricardi U, Gontero P, Ciammella P, Badellino S, Valentino F, Munoz F, Guarneri A, Rondi N, Moretto F, Filippi AR, Ragona R, and Tizzani A. Efficacy and safety of tadalafil 20 mg on demand vs. tadalafil 5 mg once-a-day in the treatment of post-radiotherapy erectile dysfunction in prostate cancer men: A randomized phase II trial. J Sex Med 2010;7:2851,2859. [source]

    ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Efficacy and Tolerability of Lodenafil Carbonate for Oral Therapy of Erectile Dysfunction: A Phase III Clinical Trial

    THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2010
    Sidney Glina MD
    ABSTRACT Introduction., This is a phase III, prospective, randomized, double-blind, placebo-controlled clinical trial on lodenafil carbonate (LC), a novel phosphodiesterase 5 inhibitor developed in Brazil. Aim., Expanding information on LC efficacy and safety. Main Outcome Measures., International Index of Erectile Function (IIEF) erectile domain, positive answers to the sexual encounter profile (SEP)-2 and SEP-3 questions and incidence of adverse events (AEs). Methods., A total of 350 men with erectile dysfunction (ED) of all degrees were randomized to placebo, LC 40 mg or LC 80 mg and followed for 4 weeks. They completed the IIEF and answered the SEP questions 2 and 3 after each intercourse without and with the use of LC. Results., IIEF Erectile Domain scores without and with the use of medication were the following (mean [M] ± standard deviation [SD]): placebo = 13.9 ± 5.2 and 14.8 ± 7.8; LC 40 mg = 13.6 ± 5.3 and 18.6 ± 8.0; LC 80 mg = 13.4 ± 4.9 and 20.6 ± 7.7 (analysis of variance [anova]P < 0.01). Positive answers to SEP-2 without and with the use of medication were the following (M ± SD): placebo = 55.3 ± 43.2% and 52.1 ± 41.4%; LC 40 mg = 46.4 ± 44.3% and 63.5 ± 42.0%; LC 80 mg = 50.2 ± 40.9% and 80.8 ± 32.3% (anovaP < 0.01). Positive answers to SEP-3 were the following: placebo = 20.2 ± 32.3% and 29.7 ± 38.1%; LC 40 mg = 19.6 ± 34.3% and 50.8 ± 44.4%; LC 80 mg = 20.8 ± 33.2% and 66.0 ± 39.3% (anovaP < 0.01). The patients with at least one AE were placebo = 28.7%, LC 40 mg = 40.9%, and LC 80 mg = 49.5%. AEs whose incidence was significantly higher with LC than with placebo included rhinitis, headache, flushing, visual disorder, and dizziness. Conclusions., LC showed a satisfactory efficacy,safety profile for oral therapy of ED. Glina S, Fonseca GN, Bertero EB, Damiăo R, Rocha LCA, Jardim CRF, Cairoli CE, Teloken C, Torres LO, Faria GE, da Silva MB, and Pagani E. Efficacy and tolerability of lodenafil carbonate for oral therapy of erectile dysfunction: A phase III clinical trial. J Sex Med 2010;7:1928,1936. [source]

    ORIGINAL RESEARCH,ERECTILE DYSFUNCTION: Independent Determinants of Coronary Artery Disease in Erectile Dysfunction Patients

    THE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010
    Shih-Tai Chang MD
    ABSTRACT Introduction., There is growing evidence of a link between erectile dysfunction (ED) and coronary artery disease (CAD). Aims., The purpose of this study was to explore the independent determinants of CAD in ED outpatients. Methods., This study enrolled 243 patients, ranging in age from 21 to 81 years old, suffering from ED as diagnosed by the International Index of Erectile Function (IIEF) scores. All patients underwent exercise stress tests or thallium-201 single-photon emission computed tomography perfusion imagings. Based on examination results, patients were divided into study (22 patients with a positive finding) and control groups (221 patients with a negative finding). Main Outcome Measures., The differences of demographic characteristics, biochemical profiles, pro-inflammatory and inflammatory markers, and echocardiographic characteristics between study and control group were compared. Results., The age, presence of DM and current smoking status were significant high in the study group. A significant lower high-density lipoprotein (HDL) cholesterol level, a higher percentage of HDL cholesterol level < 40 mg/dL, and a higher apo-lipoprotein B/A1, high sensitive C-reactive protein (hs-CRP) and homocysteine found in the study group. The Framingham cardiac risk scores, the ratio of mitral inflow velocity to early diastolic velocity in the annulus derived by tissue Doppler imaging (E/Et), the ratio of E/Et , 15, the value of carotid intima-media thickness (IMT), and IMT , 1 mm were higher in study group than in the control group. In stepwise multiple logistic regression analysis, a high waist-to-hip ratio (WHR), high IMT, high E/Et, hs-CRP levels, LDL cholesterol , 130 mg/dL, smoking status, and the presence of DM and metabolic syndrome (MS) were independent determinants of CAD in ED patients. Conclusions., This study first shows the independent determinants of CAD in ED outpatients. This novel finding may improve the screening of low-risk ED patients for CAD. Chang S-T, Chu C-M, Hsu J-T, Hsiao J-F, Chung C-M, Ho C, Peng Y-S, Chen P-Y, and Shee J-J. Independent determinants of coronary artery disease in erectile dysfunction patients. J Sex Med 2010;7:1478,1487. [source]

    The Prevalence of Erectile Dysfunction in Post-Treatment Colorectal Cancer Patients and Their Interests in Seeking Treatment: A Cross-Sectional Survey in the West-Midlands

    THE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010
    Richard Ellis MBChB
    ABSTRACT Introduction., Erectile dysfunction (ED) is a recognized complication of colorectal cancer treatment, particularly if surgery is below the recto-sigmoid junction (RSJ), and is an important quality-of-life issue. Previous studies have generated inconsistent prevalence estimates. Aim., We aimed to establish the prevalence of ED in postsurgery colorectal cancer patients and to establish what proportion wished to seek treatment. Main Outcome Measures., Questionnaire: sociodemographics, treatment methods, International Index of Erectile Function (IIEF)-5 questionnaire (validated tool to assess erectile function): score of <21 being used to define ED. Methods., Cross-sectional survey. Inclusion criteria: adult male colorectal cancer patients diagnosed in 2000,2007, treated with curative intent in one teaching hospital. Statistical analysis: logistic regression analysis to determine predictors of ED. Results., The response rate was 46% (229/499). Respondents were aged 28 to 95 years; the majority were white (93.9%), more than half (57.1%) were in a sexual relationship, only a third reported having sex in the past 6 months (33.3%). The vast majority (75.1%; 172/229) of responders had ED as defined by the IIEF-5. ED was significantly associated with increasing age (P < 0.0005), having a malignancy below the RSJ (P = 0.002), having previous radiotherapy (P = 0.007), and having a stoma (P = 0.014). Those with ED were less likely to be in a sexual relationship (P = 0.002) and less likely to have had sex in the last 6 months (P < 0.0005). Only 29% of those with ED were not interested in treatment for their condition. Conclusions., These data suggest a prevalence rate of ED of 75% in colorectal cancer survivors; this may be functional or psychological in origin. Quality of life may be improved if follow-up clinics for cancer survivors not only concentrated on the detection of recurrence but also offered assessment of erectile function and referral for patients who desire treatment. Ellis R, Smith A, Wilson S, Warmington S, and Ismail T. The prevalence of erectile dysfunction in post-treatment colorectal cancer patients and their interests in seeking treatment: A cross-sectional survey in the west-midlands. J Sex Med 2010;7:1488,1496. [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]

    Effects of Weight Loss Intervention on Erectile Function in Older Men with Type 2 Diabetes in the Look AHEAD Trial

    THE JOURNAL OF SEXUAL MEDICINE, Issue 1pt1 2010
    Rena R. Wing PhD
    ABSTRACT Introduction., Overweight men with diabetes often report erectile dysfunction (ED), but few studies have examined effects of weight loss on this problem. Aim., This study examined 1-year changes in erectile function (EF) in overweight/obese men with type 2 diabetes participating in the Look AHEAD (Action for Health in Diabetes) trial. Methods., Participants in Look AHEAD were randomly assigned to a control condition involving diabetes support and education (DSE) or to intensive lifestyle intervention (ILI) involving group and individual sessions to reduce weight and increase physical activity. Men from five of the clinical sites in Look AHEAD completed the International Index of Erectile Function (IIEF) at baseline (N = 372) and at 1 year (N = 306) (82%). Main Outcome Measures., Changes in EF as reported on the EF subscale of the IIEF. Results., At 1 year, the ILI group lost a greater percent of initial body weight (9.9% vs. 0.6 %) and had greater improvements in fitness (22.7% vs. 4.6%) than DSE. EF improved more in ILI (17.3 ± 7.6 at baseline; 18.6 ± 8.1 at 1 year) than in DSE (18.3 ± 7.6 at baseline; 18.4 ± 8.0 at 1 year); P = 0.04 and P = 0.06 after adjusting for baseline differences. Using established norms for none (i.e., normal EF), and three grades (i.e., mild, moderate, and severe) ED, 8% of men in ILI reported a worsening of EF from baseline to 1 year, 70% stayed in the same category, and 22% reported improvements. In contrast, 20% of DSE reported worsening, 57% stayed in the same category, and 23% improved (P = 0.006). Conclusion., In this sample of older overweight/obese diabetic men, weight loss intervention was mildly helpful in maintaining EF. Wing RR, Rosen RC, Fava JL, Bahnson J, Brancati F, Gendrano INC, Kitabchi A, Schneider SH, and Wadden TA. Effects of weight loss intervention on erectile function in older men with type 2 diabetes in the look AHEAD trial. J Sex Med 2010;7:156,165. [source]

    The Relevance of Sexual Responsiveness to Sexual Function in Male Stroke Patients

    THE JOURNAL OF SEXUAL MEDICINE, Issue 12 2009
    Annelien Duits PhD
    ABSTRACT Introduction., Stroke may have negative consequences for the patients' quality of life, including sexual function. Whereas physical impairment will influence sexual positions and movement during sex, depression and medication may reduce sexual desire. So far, data on sexual dysfunction after stroke are scant. Although some support for physical as well as psychological explanations has been shown, further research to find the remedies for those patients with sexual problems after stroke is needed. The focus of the present study is on the identification of relevant psychological factors. Aim., The aim of this study was to study the impact of anxiety, depression, and sexual responsiveness on sexual function in male stroke patients. Methods., Nineteen male stroke patients completed a number of self-report measures to assess psychological and sexual factors. Main Outcome Measures., Sexual function based on the International Index of Erectile Function, anxiety and depression based on the Symptom Checklist-90, and sexual responsiveness based on the Sexual Inhibition/Sexual Excitation Scale, including propensities for sexual excitation and sexual inhibition as a result of both performance failure and performance consequences, were assessed. Results., Sexual excitation was positively related to sexual desire, whereas inhibition because of the threat of performance failure was negatively related to orgasmic function and sexual desire (P < 0.01). Patients with high levels of inhibition because of threat of performance failure were more likely to report low scores on overall sexual function than those with low levels. Conclusions., Although the statistical power is rather low, the results show the relevance of sexual responsiveness to sexual function in male stroke patients. The present study can be considered as a first step toward building a theoretical framework of relevant psychological and physical factors, which is needed to develop adequate interventions for those patients with sexual problems after stroke. Duits A, van Oirschot N, van Oostenbrugge RJ, and van Lankveld J. The relevance of sexual responsiveness to sexual function in male stroke patients. J Sex Med 2009;6:3320,3326. [source]

    ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Sildenafil Citrate 100 mg Starting Dose in Men with Erectile Dysfunction in an International, Double-Blind, Placebo-Controlled Study: Effect on the Sexual Experience and Reducing Feelings of Anxiety About the Next Intercourse Attempt

    THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2009
    Oleg B. Loran MD
    ABSTRACT Introduction., Sildenafil citrate 50 mg is the recommended starting dose for men with erectile dysfunction (ED); however, most men are later titrated to sildenafil 100 mg for improved efficacy. Aim., Assess the tolerability and efficacy of sildenafil initiated at the 100-mg dose in men with ED. Methods., Men with ED (score ,25 on the Erectile Function domain of the International Index of Erectile Function) who had received ,6 total doses of a phosphodiesterase type 5 inhibitor and none within 4 weeks were randomized to 8 weeks of double-blind, placebo-controlled (DBPC), fixed-dose treatment (50 or 100 mg sildenafil or placebo) followed by 4 weeks of open-label flexible-dose sildenafil (50 or 100 mg). Main Outcome Measures., Efficacy, tolerability, treatment satisfaction, and other end points were measured at baseline and/or the end of the double-blind and open-label phases and compared between placebo and sildenafil initiated at doses of 50 and 100 mg. Results., Improvements in DBPC patient-reported outcomes from baseline were statistically significant for both sildenafil 50 and 100 mg compared with placebo. At the end of DBPC treatment, 56% of men on the 100-mg dose felt no anxiety about the next intercourse attempt compared with 39% in the 50-mg group (odds ratio 2.03; P = 0.0197). Changes in functional scores from baseline were not statistically significant with the 100-mg dose compared with the 50-mg dose in the DBPC. Measures of treatment satisfaction and sexual experience significantly favored the 100-mg dose compared with the 50-mg dose in the DBPC. There was no increase in adverse events with the higher dose. Conclusions., Sildenafil at 50 mg or 100 mg significantly improved erection quality, treatment satisfaction, anxiety levels, and the sexual experience compared with placebo during DBPC. Sildenafil 100 mg improved the sexual experience and treatment satisfaction, and reduced feelings of anxiety compared with the 50-mg dose. Loran OB, Ströberg P, Lee SW, Park NC, Kim SW, Tseng LJ, Collins S, and Stecher VJ. Sildenafil citrate 100 mg starting dose in men with erectile dysfunction in an international, double-blind, placebo-controlled study: Effect on the sexual experience and reducing feelings of anxiety about the next intercourse attempt. J Sex Med 2009;6:2826,2835. [source]

    Improved Erectile Function after Cardiac Resynchronization Therapy in a Patient with Heart Failure,A Case Report

    THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2009
    Damian Domanski MD
    ABSTRACT Introduction., Erectile dysfunction (ED) is very common among heart failure patients and has a very dramatic, negative impact on patients' quality of life. Both ED and heart failure have several risk factors in common; however, little data exist on the correlation between the heart failure-targeted interventions and improvement of ED. Aim., To report a case of improved sexual function after cardiac resynchronization. Methods., We report the case of a 63-year-old man with ischemic cardiomyopathy and long-standing ED, who experienced significant improvement of his sexual function following biventricular pacing device implantation. Notably, earlier interventions attempting to improve his ED, namely, heart failure medication adjustments and phosphodiesterase-5 inhibitors, have failed. Results., Following cardiac resynchronization therapy, patient's erectile function improved without any other ED-specific treatment. Conclusions., To the best of our knowledge, this is the first report of improved sexual function in a patient with heart failure and ED following cardiac resynchronization therapy. Although the exact mechanisms remain unknown, we believe that cardiac resynchronization improves ED through improved cardiac and endothelial function. Domanski D, Rosanio S, and Schwarz ER. Improved erectile function after cardiac resynchronization therapy in a patient with heart failure,a case report. J Sex Med 2009;6:2910,2914. [source]

    Hydration Increases Tissue Perfusion and Thus Erectile Function

    THE JOURNAL OF SEXUAL MEDICINE, Issue 9 2009
    Simon N. Thornton
    [source]

    Sexual Function in F-111 Maintenance Workers: The Study of Health Outcomes in Aircraft Maintenance Personnel

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009
    Anthony Brown MPH
    ABSTRACT Introduction., In Australia, four formal F-111 fuel tank deseal/reseal (DSRS) repair programs were implemented over more than two decades, each involving different processes and using a range of hazardous substances. However, health concerns were raised by a number of workers. The "Study of Health Outcomes in Aircraft Maintenance Personnel" was commissioned by the Australian Department of Defence to investigate potential adverse health outcomes as a result of being involved in the deseal/reseal processes. Aim., To compare measures of sexual function in F-111 aircraft fuel tank DSRS maintenance workers, against two appropriate comparison groups. Methods., Exposed and comparison participants completed a postal questionnaire which included general questions of health and health behavior, and two specific questions on sexual functioning. They also completed the International Index of Erectile Function (IIEF) questionnaire. Logistic regression was used to explore exposure status and outcome while adjusting for potential confounders. Main Outcome Measures., The three outcomes of interest for this study were the proportion of participants with erectile dysfunction (ED) according to the IIEF, the proportion with self-reported loss of interest in sex, and the proportion with self-reported problems with sexual functioning. Results., Compared with each of the comparison groups, a larger proportion of the exposed group reported sexual problems and were classified as having ED according to the IIEF. In logistic regression, the odds of all three outcomes were higher for exposed participants relative to each comparison group and after adjustment for potentially confounding variables including anxiety and depression. Conclusions., There was a consistent problem with sexual functioning in the exposed group that is not explained by anxiety and depression, and it appears related to DSRS activities. Brown A, Gibson R, Tavener M, Guest M, D'Este C, Byles J, Attia J, Horsley K, Harrex W, and Ross J. Sexual function in F-111 maintenance workers: The study of health outcomes in aircraft maintenance personnel. J Sex Med 2009;6:1569,1578. [source]

    ORIGINAL RESEARCH,EJACULATORY DISORDERS: Quantitative Sensory Testing of Peripheral Thresholds in Patients with Lifelong Premature Ejaculation: A Case-Controlled Study

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009
    Andrea Salonia MD
    ABSTRACT Introduction., The main functional factors related to lifelong premature ejaculation (PE) etiology have been suggested to be penile hypersensitivity, greater cortical penile representation, and disturbance of central serotoninergic neurotransmission. Aims., To quantitatively assess penile sensory thresholds in European Caucasian patients with lifelong PE using the Genito-Sensory Analyzer (GSA, Medoc, Ramat Yishai, Israel) as compared with those of an age-comparable sample of volunteers without any ejaculatory compliant. Methods., Forty-two consecutive right-handed, fully potent patients with lifelong PE and 41 right-handed, fully potent, age-comparable volunteers with normal ejaculatory function were enrolled. Each man was assessed via comprehensive medical and sexual history; detailed physical examination; subjective scoring of sexual symptoms with the International Index of Erectile Function; and four consecutive measurements of intravaginal ejaculatory latency time with the stopwatch method. All men completed a detailed genital sensory evaluation using the GSA; thermal and vibratory sensation thresholds were computed at the pulp of the right index finger, and lateral aspect of penile shaft and glans, bilaterally. Main Outcome Measures., Comparing quantitatively assessed penile thermal and vibratory sensory thresholds between men with lifelong PE and controls without any ejaculatory compliant. Results., Patients showed significantly higher (P < 0.001) thresholds at the right index finger but similar penile and glans thresholds for warm sensation as compared with controls. Cold sensation thresholds were not significantly different between groups at the right index finger or penile shaft, but glans thresholds for cold sensation were bilaterally significantly lower (P = 0.01) in patients. Patients showed significantly higher (all P , 0.04) vibratory sensation thresholds for right index finger, penile shaft, and glans, bilaterally, as compared with controls. Conclusions., Quantitative sensory testing analysis suggests that patients with lifelong PE might have a hypo- rather than hypersensitivity profile in terms of peripheral sensory thresholds. The peripheral neuropathophysiology of lifelong PE remains to be clarified. Salonia A, Saccŕ A, Briganti A, Carro UD, Dehň F, Zanni G, Rocchini L, Raber M, Guazzoni G, Rigatti P, and Montorsi F. Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation: A case-controlled study. J Sex Med 2009;6:1755,1762. [source]

    Sexual Function and Tunica Albuginea Wound Healing Following Penile Fracture: An 18-year Follow-Up Study of 352 Patients from Kermanshah, Iran

    THE JOURNAL OF SEXUAL MEDICINE, Issue 4 2009
    Javaad Zargooshi MD
    ABSTRACT Introduction., We present a study on the experiences of penile fracture in an Iranian population. Aim., To determine the long-term outcome of penile fracture. Methods., Between April 1990 and May 2008, 373 patients presented with clinical features suggestive of penile fracture. Of these, 11 declined surgery. The remaining 362 were operated upon using a degloving incision. Ten patients had venous injury and 352 had penile fracture. At follow-up visits, in addition to answering our questionnaire, the patients completed the International Index of Erectile Function (IIEF), Erection Hardness Grading Scale (EHGS), and global self-assessment of potency (GSAP). To enhance documentation and to promote transparency, with the patients' permission, their full name and hospital chart number was sent to the journal. Main Outcome Measures., Clinical findings and IIEF and EHGS scores. Results., Mean patients' age was 29.6 years. Mean duration of follow-up was 93.6 months. Diagnosis was solely clinical. At presentation, 278 (78.9%) reported no pain. Cavernosography, ultrasonography, or magnetic resonance imaging was not used in any of the patients. Penile fracture was due to taqaandan in 269 patients (76.4%). Patients were treated with surgical exploration and repair within 24 hours of admission, regardless of delay in presentation. A nodule was found at follow-up in 330 patients (93.7%). The painless, mostly proximal nodule was palpated at the floor of the corpora cavernosa, in a deep midline position above the corpus spongiosum. The non-expansive nodule was not associated with erectile dysfunction (ED) or Peyronie's disease. Postoperative complications included mild penile pain in cold weather (two patients), transient wound edema (one patient), mild chordee (four patients), and occasional instability of the erect penis (one patient). Postoperatively, of the 217 patients who had partners, 214 (98.6%) were potent. Mean IIEF ED domain score was 29.8 ± 1.1. The EHGS score was 4 in 203 and 3 in 11. The GSAP score was 0 in 204, 1 in 8, and 2 in 2. ED in the remaining three could not be explained by penile fracture. Of 10 nonoperated patients, eight (80%) developed ED. Conclusion., Pain is rare in penile fracture. Postoperatively, almost all patients develop a permanent, inconsequential, fibrotic nodule. Our time-tested approach provided excellent long-term sexual function. Zargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran. J Sex Med **;**:**,**. [source]

    Treatment of Nonparaphilic Hypersexuality in Men with a Long-Acting Analog of Gonadotropin-Releasing Hormone

    THE JOURNAL OF SEXUAL MEDICINE, Issue 4 2009
    Mohammad R. Safarinejad MD
    ABSTRACT Introduction., Hypersexuality is one of the most embarrassing behaviors for both patients and their families and there are no effective drug treatments for this sexual inappropriateness. Aim., To evaluate the efficacy and safety of a long-acting analog of gonadotropin-releasing hormone (triptorelin) in men with nonparaphilic hypersexuality (NPH). Main Outcome Measures., Primary outcome measure was the frequency of intercourse. The designated secondary outcome measures were the changes in International Index of Erectile Function (IIEF) questionnaire and responses to the questions from the IIEF in the preceding month: question 11, "How often have you felt sexual desire?" and question 12, "How would you rate your level of sexual desire"? Methods., Seventy-six men (mean age 44.4 years) with NPH were treated with monthly intramuscular injections of 3.75 mg of triptorelin for an indefinite period. During treatment, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, testosterone (T), and free testosterone (fT), were measured monthly, and bone mineral density every 6 months. Results., The mean sexual attempts decreased from 7.6 ± 1.4 per day at baseline to 4.2 ± 1.2 (P = 0.001), 1.2 ± 0.4 (P = 0.001), and <1 per week (P = 0.0001), after 6-, 12-, and 24-month treatment, respectively. The mean scores for questions 11 and 12, improved from 6.8 ± 1.1, and 6.6 ± 1.2, at baseline to 0.7 ± 0.4 (P = 0.0001), and 0.7 ± 0.5 (P = 0.0001), at 24-month treatment, respectively. Positive response to triptorelin was significantly associated with severity of baseline hypersexuality (r = ,0.62, P = 0.01), and treatment duration (r = 0.78, P = 0.001). These beneficial effects persisted 6 months in all men who were treated for at least 24 months. The serum LH and FSH concentrations begun to decrease after two doses of triptorelin. After 3 months, serum T, and fT levels decreased by 50% in 65 (85.5%) of patients (P = 0.01). Conclusions., Triptorelin was very effective and well tolerated in men with NPH. Further studies are needed to replicate our results. Safarinejad MR. Treatment of nonparaphilic hypersexuality in men with a long-acting analog of gonadotropin-releasing hormone. J Sex Med **;**:**,**. [source]

    Erectile Function in Two-Kidney, One-Clip Hypertensive Rats is Maintained by a Potential Increase in Nitric Oxide Production

    THE JOURNAL OF SEXUAL MEDICINE, Issue S3 2009
    A. Elizabeth Linder PhD
    ABSTRACT Introduction., Hypertension is closely associated with erectile dysfunction (ED) as it has been observed in many experimental models of hypertension. Additionally, epidemiological studies show that approximately a third of hypertensive patients have ED. Aim., To test the hypothesis that the two-kidney, one-clip (2K-1C) rat model of hypertension displays normal erectile function due to increased nitric oxide (NO) production in the penis. Methods., Ganglionic-induced increase in intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio was used as an index of erectile function in 2K-1C and in normotensive sham-operated (SHAM) anesthetized rats. Cavernosal strips from hypertensive and normotensive rats were used for isometric tension measurement. The contraction induced by alpha-adrenergic agonist phenylephrine and the relaxation induced by the NO donor sodium nitroprusside (SNP) and by the Rho-kinase inhibitor Y-27632 were performed in the absence and in the presence of the NO synthase inhibitor N, -nitro-L-arginine (L-NNA). Results., Changes in ICP/MAP induced by ganglionic stimulation were not different between 2K-1C and SHAM rats. The contractile response induced by phenylephrine as well as the relaxation induced by SNP or the Y-27632 were similar in cavernosal strips from both groups. However, in the presence of L-NNA, the relaxation induced by Y-27632 was significantly impaired in 2K-1C compared to SHAM. Conclusions., These data suggest that hypertension and ED could be dissociated from high levels of blood pressure in some animal models of hypertension. Erectile function in 2K-1C hypertensive rats is maintained in spite of the increased Rho-kinase activity by increased NO signaling. Linder AE, Dorrance AM, Mills TM, Webb RC, and Leite R. Erectile function in two-kidney, one-clip hypertensive rats is maintained by a potential increase in nitric oxide production. J Sex Med 2009;6(suppl 3):279,285. [source]

    ORIGINAL RESEARCH,PEYRONIE'S DISEASE: Use of Penile Extender Device in the Treatment of Penile Curvature as a Result of Peyronie's Disease.

    THE JOURNAL OF SEXUAL MEDICINE, Issue 2 2009
    Results of a Phase II Prospective Study
    ABSTRACT Introduction., Pilot experiences have suggested that tension forces exerted by a penile extender may reduce penile curvature as a result of Peyronie's disease. Aim., To test this hypothesis in a Phase II study using a commonly marketed brand of penile extender. Methods., Peyronie's disease patients with a curvature not exceeding 50° with mild or no erectile dysfunction (ED) were eligible. Fifteen patients were required to test the efficacy of the device assuming an effect size of >0.8, consistent with an "important" reduction in penile curvature. Changes in penile length over baseline and erectile function (EF) domain scores of the International Index of Erectile Function (IIEF) constituted secondary end points. Main Outcome Measures., Patients were counselled on the use of the penile extender for at least 5 hours per day for 6 months. Photographic pictures of the erect penis and measurements were carried out at baseline, at 1, 3, 6, and 12 months (end of study). The IIEF-EF domain scores were administered at baseline and at the end of study. Treatment satisfaction was assessed at end of study using a nonvalidated institutional 5-item questionnaire. Results., Penile curvature decreased from an average of 31° to 27° at 6 months without reaching the effect size (P = 0.056). Mean stretched and flaccid penile length increased by 1.3 and 0.83 cm, respectively at 6 months. Results were maintained at 12 months. Overall treatment results were subjectively scored as acceptable in spite of curvature improvements, which varied from "no change" to "mild improvement." Conclusions., In our study, the use of a penile extender device provided only minimal improvements in penile curvature but a reasonable level of patient satisfaction, probably attributable to increased penile length. The selection of patients with a stabilized disease, a penile curvature not exceeding 50°, and no severe ED may have led to outcomes underestimating the potential efficacy of the treatment. Gontero P, Di Marco M, Giubilei G, Bartoletti R, Pappagallo G, Tizzani A, and Mondaini N. Use of penile extender device in the treatment of penile curvature as a result of Peyronie's disease. Results of a phase II prospective study. J Sex Med 2009;6:558,566. [source]

    Putative Role of Carbon Monoxide Signaling Pathway in Penile Erectile Function

    THE JOURNAL OF SEXUAL MEDICINE, Issue 1 2009
    Mohamed T. Abdel Aziz MD
    ABSTRACT Introduction., Erectile response depends on nitric oxide (NO) generated by NO synthase (NOS) enzyme of the nerves and vascular endothelium in the cavernous tissue. NO activates soluble guanylate cyclase (sGC), leading to the production of cyclic guanosine monophosphate (cGMP). cGMP activates cGMP-dependent protein kinase that activates Ca2+/ATPase pump that activates Ca2+/K efflux pump extruding Ca2+ across the plasma membrane with consequent smooth muscle cell relaxation. A role similar to that of NOS/NO signaling has been postulated for carbon monoxide (CO) produced in mammals from heme catabolism by heme oxygenase (HO) enzyme. Aim., To assess CO signaling pathway for erectile function by reviewing published studies. Methods., A systematic review of published studies on this affair based on Pubmed and Medical Subject Heading databases, with search for all concerned articles. Main Outcome Measures., Documentation of positive as well as negative criteria of CO/HO signaling focused on penile tissue. Results., The concept that HO-derived CO could play a role in mediating erectile function acting in synergism with, or as a potentiator for, NOS/NO signaling pathway is gaining momentum. CO/HO signaling pathway has been shown to partially mediate the actions of oral phosphodiesterase type 5 inhibitors. In addition, it was shown that the use of CO releasing molecules potentiated cavernous cGMP levels. However, increased CO production or release was reported to be associated, in some studies, with vasoconstriction. Conclusion., This review sheds a light on the significance of cavernous tissue CO signaling pathway that may pave the way for creation of therapeutic modalities based on this pathway. Abdel Aziz MT, Mostafa T, Atta H, Wassef MA, Fouad HH, Rashed LA, and Sabry D. Putative role of carbon monoxide signaling pathway in penile erectile function. J Sex Med 2009;6:49,60. [source]

    Evaluation of the Association between Lower Urinary Tract Symptoms and Erectile Dysfunction, Considering its Multiple Risk Factors

    THE JOURNAL OF SEXUAL MEDICINE, Issue 11 2008
    Ernani Luis Rhoden MD
    ABSTRACT Aim., To investigate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), while considering multiple risk factors for ED, including an anthropometric evaluation of central obesity. Methods., A cross-sectional study was carried out with 192 consecutive male subjects (,40 years old). Conditions clearly associated with ED, other than obesity and age, were considered exclusion criteria. Men were evaluated routinely for clinical history, received a physical examination, and were subjected to blood analysis for fasting serum glucose, lipid profile, and serum testosterone. Patients with previous known history of diabetes mellitus or hypertension were excluded. Anthropometric measures taken included body mass index (general obesity) and waist circumference, waist-hip index, and sagittal abdominal diameter (visceral obesity). Analyses were performed using bivariate and multivariate models (multiple logistic regression). Age, education, alcohol consumption, smoking, sedentary lifestyle, fasting blood glucose level, dyslipidemia, hypogonadism, general obesity, and visceral obesity were taken into account as potential confounding factors. Main Outcome Measures., All men completed the International Index of Erectile Function and International Prostate Symptom Score (IPSS). Results., IPSS scores were low, intermediate, and high in 89 (46.4%), 76 (39.6%), and 27 (14.1%) men, respectively. Overall IPSS scores were significantly associated with ED (P = 0.002). In addition, an association between the severity of ED and LUTS was observed (P = 0.008). The mean quality of life assessment in the IPSS revealed a statistically significant difference between individuals with varying degrees of ED (P = 0.008). The logistic regression analyses showed that IPSS scores and ED remained independently associated even after the control for confounding factors (odds ratio = 1.07, 95% CI = 1.02,1.13, P = 0.01). Conclusion., This study suggests that LUTS are independently associated with ED, taking into account various risk factors for ED, including visceral obesity. Rhoden EL, Riedner CE, Fornari A, Fuchs SC, and Ribeiro EP. Evaluation of the association between lower urinary tract symptoms and erectile dysfunction, considering its multiple risk factors. J Sex Med 2008;5:2662,2668. [source]

    An Open-Label, Multicenter, Flexible Dose Study to Evaluate the Efficacy and Safety of Viagra® (Sildenafil Citrate) in Korean Men with Erectile Dysfunction and Arterial Hypertension who are Taking Antihypertensive Agents

    THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2008
    Hyun Jun Park MD
    ABSTRACT Introduction., Erectile dysfunction (ED) is common among men taking antihypertensive agents to control blood pressure. Aim., We evaluated the efficacy and safety of sildenafil citrate in men with ED taking antihypertensive agents. Methods., A total of 198 male subjects, aged 20 years and older were enrolled. This study was conducted for 10 weeks as an open-label, multicenter and flexible dose trial with a 2-week screening period and an 8-week treatment phase. Main Outcome Measures., Subjects were asked to complete Event Log Worksheets, as well as the International Index of Erectile Function (IIEF) and the Global Efficacy Assessment Questions (GEAQ) questionnaires during the study period. Results., The average age among the 167 subjects who completed the study was 55.8 (31.7 to 77.1). The scores for questions 3 and 4 of IIEF improved from 2.3 and 1.8 at baseline to 3.7 and 3.4 at week 4 and 3.8 and 3.4 at week 8, respectively. There were 86.3% of the patients reported improved erectile function at week 8; 88.3% of the patients reported improved ability to achieve sexual intercourse at week 8. There were no significant differences observed in the responses to questions 3 and 4 of IIEF and GEAQ by the number of antihypertensive agents taken. The adverse events were facial flushing (20.1%), headache (11.7%), palpitation (5.0%), rhinitis (2.8%), URI (2.8%), dizziness (2.2%), dyspnea (2.2%), and nausea (1.7%). Conclusions., Sildenafil citrate is an effective treatment for ED; it is safe and well tolerated by patients with ED taking multiple antihypertensive agents for arterial hypertension. Park HJ, Park NC, Shim HB, Park JK, Lee SW, Park K, Kim SW, Moon KH, Lee DH, and Yoon SJ. An open-label, multicenter, flexible dose study to evaluate the efficacy and safety of Viagra® (sildenafil citrate) in Korean men with erectile dysfunction and arterial hypertension who are taking antihypertensive agents. J Sex Med 2008;5:2405,2413. [source]

    Long-Term Safety and Efficacy of Tadalafil 5 mg Dosed Once Daily in Men with Erectile Dysfunction

    THE JOURNAL OF SEXUAL MEDICINE, Issue 9 2008
    Hartmut Porst MD
    ABSTRACT Introduction., With once-daily administration of tadalafil, dosing and sexual activity would no longer need to be temporally linked for patients with erectile dysfunction (ED). Aim., To evaluate long-term safety and efficacy of tadalafil 5 mg dosed once daily for the treatment of ED. Methods., Patients ,18 years of age with ED of any functional severity or etiology received tadalafil 5 mg once daily for 1 (N = 234) or 2 (N = 238) years during the open-label extensions of two previously reported studies. Patients who completed the 1-year open-label extension concluded with a 4-week ED treatment-free period. Baseline was defined as prior to receiving any study drug. Main Outcome Measures., Safety measures included adverse events, electrocardiograms, and clinical laboratory measures. Efficacy measures included the International Index of Erectile Function (IIEF)-Erectile Function (-EF), -Intercourse Satisfaction (-IS), and -Overall Satisfaction (-OS) domain scores, and the Global Assessment Questions (GAQ1: improved erections; GAQ2: improved ability to engage in sexual activity). Results., Overall, 208/234 (88.9%) and 139/238 (58.4%) patients completed the 1- and 2-year open-label extensions, respectively. No study drug-related serious adverse events were observed. Treatment-emergent adverse events observed in ,5% of the patients during the first year of either open-label extension were dyspepsia, headache, back pain, and influenza. No clinically meaningful abnormalities associated with tadalafil were observed for electrocardiograms or clinical laboratory measures. Mean IIEF domain scores improved from baseline to the conclusions of the 1- and 2-year open-label extensions, respectively: -EF, +10.4 and +10.8; -IS, +4.0 and +3.7; and -OS, +3.0 and +3.2. At the conclusion of the 2-year open-label extension, 95.7% and 92.1% of the patients reported positive responses to GAQ1 and GAQ2, respectively. Conclusions., In these long-term, open-label, once-daily dosing studies, tadalafil 5 mg was well tolerated and effective, making it a viable alternative to the current on-demand dosing of tadalafil for men with ED. Porst H, Rajfer J, Casabé A, Feldman R, Ralph D, Vieiralves LF, Esler A, Wolka AM, and Klise SR. Long-term safety and efficacy of tadalafil 5 mg dosed once daily in men with erectile dysfunction. J Sex Med 2008;5:2160,2169. [source]

    Intracavernous Growth Differentiation Factor-5 Therapy Enhances the Recovery of Erectile Function in a Rat Model of Cavernous Nerve Injury

    THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2008
    Thomas M. Fandel
    ABSTRACT Introduction., Neurogenic erectile dysfunction remains a serious complication in the postprostatectomy population. Effective protective and regenerative neuromodulatory strategies are needed. Aim., To determine the effect of growth differentiation factor-5 (GDF-5) on erectile function and its mechanism in a rat model of cavernous nerve (CN) injury. Main Outcome Measures., Erectile function was assessed by CN electrostimulation at 4 weeks. Penile tissues were examined by real-time polymerase chain reaction (PCR) and immunohistochemical analyses. Methods., Forty-eight male Sprague-Dawley rats were randomly divided into six equal groups: one group underwent sham operation (uninjured controls), while five groups underwent bilateral CN crush. Crush-injury groups were treated at the time of injury with intracavernous injection of a slow-release suspension of liquid microparticles containing no GDF-5 (vehicle), 0.4 µg (low concentration), 2 µg (intermediate concentration), or 10 µg GDF-5 (high concentration). One untreated group served as injured controls. Results., GDF-5 enhanced erectile recovery and significantly increased intracavernous pressure in the low and intermediate-concentration groups vs. injured controls. Low-concentration GDF-5 demonstrated the best functional preservation, as the intracavernous pressure increase in this group did not differ significantly from uninjured controls. A dose-response relationship was confirmed for the effects of GDF-5 in penile tissue. Low-concentration GDF-5 showed better preservation of the penile dorsal nerves and antiapoptotic effects in the corpus cavernosum (P < 0.05 vs. injured controls). Although high concentration GDF-5 did not confer meaningful erectile recovery, this dose was more effective at decreasing transforming growth factor-, than low-concentration GDF-5. Conclusions., Intracavernous injection of low (0.4 µg) or intermediate-concentration GDF-5 (2 µg) was effective in preserving erectile function in a rat model of neurogenic erectile dysfunction. The underlying mechanism appears to involve neuron preservation and antiapoptosis. Fandel TM, Bella AJ, Lin G, Tantiwongse K, Lin C-S, Pohl J, and Lue TF. Intracavernous growth differentiation factor-5 therapy enhances the recovery of erectile function in a rat model of cavernous nerve injury. J Sex Med 2008;5:1866,1875. [source]