Relationship between Premature Ejaculation and Chronic Prostatitis/Chronic Pelvic Pain Syndrome

IntroductionChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common etiology of premature ejaculation (PE). However, the current data are insufficient to explain this relationship and to support routine screening of men with PE.AimsThis study aims to evaluate the relationship between PE and CP/CPPS.MethodsA cross‐sectional study was conducted that included 8,261 men who had participated in a health examination. The Premature Ejaculation Diagnostic Tool (PEDT), the National Institutes of Health‐Chronic Prostatitis Symptom Index (NIH‐CPSI), and the International Index of Erectile Function‐5 (IIEF) were used for assessment of symptoms. A full metabolic work‐up and serum testosterone level checks were also performed. We then investigated the relationship using the Spearman correlation test, multiple linear regression, and logistic regression analyses.Main Outcome MeasuresAssociations of PEDT with NIH‐CPSI.ResultsThe mean age was 50.4 ± 5.5 years. In total, 2,205 (24.9%) men had prostatitis‐like symptoms (NIH‐CPSI pain score of ≥4 and perineal or ejaculatory pain), and 618 (7.0%) men had moderate to severe symptoms (NIH‐CPSI pain score of ≥8). Additionally, 2,144 men (24.2%) were classified as demonstrating PE (PEDT > 10). The PEDT score was found to have a significant positive correlation with the NIH‐CPSI pain domain score (correlation coefficient = 0.206; P < 0.001). After adjusting for age, metabolic syndrome status, testosterone level, and IIEF score, there was no change in the positive correlation between the NIH‐CPSI pain domain score and PEDT score (Beta = 0.175; P < 0.001). After adjusting for age, testosterone level, metabolic syndrome, and IIEF score, the odds ratio (OR) for PE significantly increased with the severity of pelvic pain (mild prostatitis‐like symptoms, OR for PE: 1.269, 95% confidence interval: 1.113–1.447; moderate to severe symptoms, OR for PE: 2.134: 95% confidence interval: 1.782–2.557).ConclusionsOur data showed a significant correlation between the PEDT score and the NIH‐CPSI score. We suggest routine screening for CP/CPPS in men with PE and PE in men with CP/CPPS. Lee JH and Lee SW. Relationship between premature ejaculation and chronic prostatitis/chronic pelvic pain syndrome. J Sex Med 2015;12:697–704.     

Chlamydia trachomatis Infection Is Related to Premature Ejaculation in Chronic Prostatitis Patients: Results from a Cross‐Sectional Study

IntroductionChronic bacterial prostatitis (CBP) is reported to be a common finding in men with acquired premature ejaculation (PE). The impact of different pathogens on PE development in chronic prostatitis patients is, however, unknown.AimTo assess a possible link between CBP caused by Chlamydia trachomatis (Ct) and PE.MethodsA consecutive series of 317 patients with clinical and instrumental diagnosis of CBP due to Ct was enrolled (group A) and compared with data obtained from a control group of 639 patients with CBP caused by common uropathogen bacteria (group B). Prostatitis symptoms were investigated with the National Institutes of Health‐Chronic Prostatitis Symptom Index (NIH‐CPSI), while the ejaculatory status of patients was assessed using the PE Diagnostic Tool (PEDT).Main Outcome MeasuresAll participants were asked to complete the NIH‐CPSI, the International Index of Erectile Function‐15 erectile function domain (IIEF‐15‐EFD), the PEDT, and the Short Form (SF)‐36 questionnaires.ResultsPatient groups A and B had comparable scores of NIH‐CPSI (P = 0.07), IPSS (P = 0.32), and IIEF‐15‐EFD (P = 0.33) tests. PE was assessed in 118 patients in group A (37.2%) and in 73 subjects in group B (11.5%). The two groups are different in terms of PE prevalence (P < 0.0002). Compared with group B, group A showed significantly higher scores of the PEDT test (11.3 [±2.6] vs. 4.5 [±2.9], P < 0.0001) and lower scores of the SF‐36 tool (96.5 [±1.1] vs. 99.7 [±1.3], P < 0.0001). In our multivariate model assessment, being positive for a Ct infection marker was independently associated with the PEDT score even after adjusting for age, smoking habit, body mass index, and education level (adjusted odds ratio = 3.21; 95% confidence interval: 2.02–4.27; P < 0.003).ConclusionsPatients affected by CBP due to Ct infection reported higher prevalence of PE and lower quality of life when compared with patients affected by CBP caused by traditional uropathogenic bacteria. Cai T, Pisano F, Magri V, Verze P, Mondaini N, D'Elia C, Malossini G, Mazzoli S, Perletti G, Gontero P, Mirone V, and Bartoletti R. Chlamydia trachomatis infection is related to premature ejaculation in chronic prostatitis patients: Results from a cross‐sectional study. J Sex Med 2014;11:3085–3092.     

Relationships Between Intravaginal Ejaculatory Latency Time and National Institutes of Health‐Chronic Prostatitis Symptom Index in the Four Types of Premature Ejaculation Syndromes: A Large Observational Study in China

IntroductionBesides lifelong premature ejaculation (LPE) and acquired premature ejaculation (APE), Waldinger and Schweitzer proposed two addition PE syndromes (variable PE [VPE] and subjective PE [SPE]).AimWe assessed the associations between intravaginal ejaculatory latency time (IELT) and National Institutes of Health‐Chronic Prostatitis Symptom Index (NIH‐CPSI) in men with different PE syndromes.MethodsFrom September 2011 to September 2012, a total of 4,000 men were enrolled from the Anhui province of China. Subjects were required to complete a verbal questionnaire, including demographic information, medical and sexual history (e.g., IELT), and self‐estimated scales (e.g., NIH‐CPSI).Main Outcome MeasuresIELT; NIH‐CPSI; the new classification of PE syndromes.ResultsOf 3,016 of the men evaluated, 25.80% complained of PE. Distribution of the four PE syndromes among men with complaints of PE was as follows: LPE, 12.34%; APE, 18.77%; VPE, 44.09%; and SPE, 24.81%. Men with complaints of PE reported worse NIH‐CPSI scores and lower IELT than men without complaints of PE (P < 0.001 for all). Moreover, total and subdomain scores of NIH‐CPSI were higher in men with APE, and IELT was higher in men with SPE. IELT was negatively associated with NIH‐CPSI scores in men with complaints of PE. Negative relationships between total and subdomain scores of NIH‐CPSI and IELT were stronger in men with APE (total scores: adjusted r = −0.68, P < 0.001; pain symptoms: adjusted r = −0.70, P < 0.001; urinary symptoms: adjusted r = −0.67, P < 0.001; quality of life impact: adjusted r = −0.64, P < 0.001).ConclusionMen with complaints of PE reported worse NIH‐CPSI scores than men without complaints of PE. Relationships between IELT and NIH‐CPSI scores were strongest in men with APE. Gao J, Xu C, Liang C, Su P, Peng Z, Shi K, Tang D, Gao P, Lu Z, Liu J, Xia L, Yang J, Hao Z, Zhou J, and Zhang X. Relationships between intravaginal ejaculatory latency time and National Institutes of Health‐Chronic Prostatitis Symptom Index in the four types of premature ejaculation syndromes: A large observational study in China. J Sex Med 2014;11:3093–3101.     

Erectile dysfunction and premature ejaculation in men who have sex with men

IntroductionQuantitative research into sexual function and dysfunction in men who have sex with men (MSM) has been sparse due in large part to a lack of validated, quantitative instruments for the assessment of sexuality in this population.AimTo assess prevalence and associations of erectile problems and premature ejaculation in MSM.MethodsMSM were invited to complete an online survey of sexual function. Ethnodemographic, sexuality, and health‐related factors were assessed.Main Outcome MeasureParticipants completed a version of the International Index of Erectile Function modified for use in MSM (IIEF‐MSM) and the Premature Ejaculation Diagnostic Tool (PEDT). Total score on the erectile function (EF) domain of the IIEF‐EF (IIEF‐MSM‐EF) was used to stratify erectile dysfunction (ED) severity (25–30 = no ED, 16–24 mild or mild moderate ED, 11–15 moderate ED, and ≤10 severe ED). PEDT scores were used to stratify risk of premature ejaculation (PE, diagnosed as PEDT score ≥9).ResultsNearly 80% of the study cohort of 2,640 men resided in North America. The prevalence of ED was higher in older men whereas the prevalence of PE was relatively constant across age groups. Multivariate logistic regression revealed that increasing age, HIV seropositivity, prior use of erectogenic therapy, lower urinary tract symptoms (LUTS), and lack of a stable sexual partner were associated with greater odds of ED. A separate multivariate analysis revealed that younger age, LUTS, and lower number of lifetime sexual partners were associated with greater odds of PE.Conclusions.Risk factors for sexual problems in MSM are similar to what has been observed in quantitative studies of non‐MSM males. Urinary symptoms are associated with poorer sexual function in MSM. Shindel AW, Vittinghoff E, and Breyer BN. Erectile dysfunction and premature ejaculation in men who have sex with men. J Sex Med 2012;9:576–584.     

Premature ejaculation and erectile dysfunction prevalence and attitudes in the Asia-Pacific region

IntroductionPremature ejaculation (PE) is a common male sexual dysfunction. The prevalence of PE in the Asia‐Pacific region has not been comprehensively studied.AimThe aim of this study is to evaluate PE prevalence in nine Asia‐Pacific countries and the impact of PE on sufferers.MethodsA random sample of heterosexual males aged 18–65 years in a stable sexual relationship currently or in the past 2 years completed a 48‐question survey by computer‐assisted interviewing, online, or in‐person; the survey and recruitment methodologies varied by location. The survey included demographic questions, the five‐question Premature Ejaculation Diagnostic Tool (PEDT), the five‐question Sexual Health Inventory for Men (SHIM), and the 10‐question Index of Premature Ejaculation (IPE). Separately, men self‐reported having PE (lifelong or acquired) or erectile dysfunction (ED).Main Outcome MeasuresThe PEDT was used to diagnose PE or probable PE; the SHIM was used to diagnose ED; and the IPE was used to assess respondent's attitudes toward PE.ResultsOf the 4,997 men who completed the survey, the prevalences of PEDT‐diagnosed PE, PEDT‐diagnosed probable PE, and self‐reported PE were 16%, 15%, and 13%, respectively. Less than half of men with PEDT‐diagnosed PE (N = 816) or probable PE (N = 738) self‐reported the condition (40% and 19%, respectively), and 6% of men with a PEDT diagnosis of no PE self‐reported PE. In contrast, more respondents self‐reported ED (8%) than had SHIM‐diagnosed moderate or severe ED (5%). IPE responses indicated that 45%, 46%, and 23% of men with PEDT‐diagnosed PE were somewhat or very dissatisfied with the length of intercourse before ejaculation, their control over ejaculation, and with sexual intercourse, respectively.Conclusions.In this study, PE was more prevalent than ED in the Asia‐Pacific countries surveyed, but only 40% of men with PEDT‐diagnosed PE self‐reported PE. McMahon CG, Lee G, Park JK, and Adaikan PG. Premature ejaculation and erectile dysfunction prevalence and attitudes in the Asia‐Pacific region. J Sex Med 2012;9:454–465.     

Relationship between Sexual Dysfunction and Psychological Burden in Men with Infertility: A Large Observational Study in China

IntroductionAlthough infertility is known to be associated with psychological and sexual problems, the relationship between these two aspects in infertile men has not been well investigated.AimTo investigate the incidence of sexual dysfunction and psychological burden, and their possible associations in infertile men.MethodsFrom June 2009 to June 2012, a total of 1,468 infertile men and 942 fertile men were evaluated. Premature ejaculation (PE) and erectile dysfunction (ED) were measured by the PE diagnostic tool (PEDT), the intravaginal ejaculatory latency time (IELT) and the international index of erectile function (IIEF)‐5. Anxiety and depression, which reflect the degree of psychological burden, were measured by the self‐rating anxiety scale (SAS) and self‐rating depression scale (SDS), respectively.Main Outcome MeasuresPE and ED were measured by the PEDT, IELT, and IIEF‐5. Anxiety and depression were measured by the SAS and SDS, respectively.ResultsThe incidences of PE and ED in the infertile group were significantly higher than those in the fertile group (PE: 19.01% vs.10.93%, P < 0.001; ED: 18.05% vs. 8.28%, P < 0.001). In addition, anxiety and depression were more prevalent in infertile than fertile men (Anxiety: 38.01% vs. 26.65%, P < 0.001; Depression: 15.74% vs. 10.08%, P < 0.001). Furthermore, after adjusting for age in the infertile group, the PEDT score was positively associated with anxiety (adjusted r = 0.57; P < 0.001) and depression (adjusted r = 0.54; P < 0.001). Moreover, the IELT were negatively associated with anxiety (adjusted r = ?0.40; P < 0.001) and depression (adjusted r = ?0.52; P < 0.001). Similar negative relationships were also observed between the IIEF‐5 score and anxiety (adjusted r = ?0.49; P < 0.001) or depression (adjusted r = ?0.50; P < 0.001).ConclusionThis is the first study to systematically evaluate the incidence of sexual dysfunction and psychological burden, and their possible associations in infertile men in China. Further in‐depth studies are needed to confirm and extend these results. Gao J, Zhang X, Su P, Liu J, Shi K, Hao Z, Zhou J, and Liang C. Relationship between sexual dysfunction and psychological burden in men with infertility: A large observational study in China. J Sex Med 2013;10:1935‐1942.     

Associations Between Premature Ejaculation,Lower Urinary Tract Symptoms,and Erectile Dysfunction in Middle‐Aged Korean Policemen

IntroductionThere is controversy concerning the relationship between premature ejaculation (PE) and erectile dysfunction (ED), as well as the scan data regarding the association between PE and lower urinary tract symptoms (LUTS).AimsWe performed this study to evaluate the association between PE and ED or LUTS.MethodsA total of 2,591 policemen aged 40–59 years who had participated in a health examination were included in this study. PE, LUTS, and ED were evaluated using the premature ejaculatory diagnostic tool (PEDT), the International Prostate Symptoms Score (IPSS), and the International Index of Erectile Function questionnaire‐5 (IIEF), respectively. Spearman's correlation test, the multiple linear regression test, and logistic regression analyses were used to evaluate the relationship between PE and ED or LUTS.Main Outcome MeasuresAssociations between PEDT, IPSS, and IIEF.ResultsThe middle age of the study group was 49.1 years, and the middle PEDT, IIEF, and IPSS was 7.5, 17.0, and 10.7, respectively. By univariate analysis, PEDT showed a significant correlation with IPSS (r = 0.310, P < 0.001) and IIEF (r = −0.413, P < 0.001). After adjusting for age, components of metabolic syndrome, testosterone, and IIEF, PEDT was significantly correlated with IPSS (Beta = 0.166, P < 0.001). PEDT was also significantly correlated with IIEF after adjusting for age, components of metabolic syndrome, testosterone, and IPSS (Beta = −0.274, P < 0.001). Additionally, the severity of LUTS or ED was associated with the PE positive ratio (P trend < 0.001). The odds ratio (OR) for PE also increased with the severity of LUTS or ED after adjusting for potential confounding factors.ConclusionsED and LUTS were significantly and independently correlated with PE. Lee JH. Associations between premature ejaculation, lower urinary tract symptoms, and erectile dysfunction in middle‐aged Korean policemen. J Sex Med 2014;11:1512–1518.     

ORIGINAL RESEARCH—ED PHARMACOTHERAPY: The Efficacy and Safety of Udenafil [Zydena] for the Treatment of Erectile Dysfunction in Hypertensive Men Taking Concomitant Antihypertensive Agents

IntroductionErectile dysfunction (ED) and hypertension are frequent comorbid conditions. The vasodilating properties of type 5 phosphodiesterase inhibitor (PDE5I) are the major concerns for the treatment of ED patients on antihypertensive medications.AimTo evaluate the efficacy and safety of Udenafil [Zydena] (Dong‐A, Seoul, Korea), a newly developed PDE5I, for the treatment of ED patients on antihypertensive medication.MethodsIt was a multicentered, randomized, double‐blind, placebo‐controlled, fix‐dosed clinical trial among 165 ED patients receiving antihypertensive medications. The subjects treated with placebo, 100 mg or 200 mg of Udenafil for 12 weeks were asked to complete the Sexual Encounter Profile (SEP) diary, the International Index of Erectile Function (IIEF), and the Global Assessment Question (GAQ) during the study period.Main Outcome MeasuresPrimary parameter: the change from baseline for IIEF erectile function domain (EFD) score; Secondary parameters: the IIEF Question 3 and 4, SEP Question 2 and 3, the rate of achieving normal erectile function (EFD ≥ 26) and the response to GAQ.ResultsCompared to placebo, patients receiving both doses of Udenafil showed significantly improved the IIEF‐EFD score. The least squares means for the change from baseline in IIEF‐EFD scores were 8.4 and 9.8 for 100 mg and 200 mg Udenafil groups, respectively; those values were significantly higher than that of placebo (2.4, P < 0.0001). Similar results were observed in the comparison of Q3 and Q4 of IIEF, SEP diary and GAQ. Headache and flushing were the most common treatment‐emergent adverse events, which were transient and mild‐to‐moderate in nature. No parameters of efficacy and safety were affected among the subsets stratified according to either the number of antihypertensive medication received or the previous experience of PDE5Is treatment.ConclusionUdenafil significantly improved erectile function among ED patients with hypertensive symptom treated with concomitant antihypertensive medication. The treatment did not increase the frequency or severity of adverse events. Paick J‐S, Kim SW, Park YK, Hyun JS, Park NC, Lee SW, Park K, Moon KH, and Chung WS. The efficacy and safety of Udenafil [Zydena] for the treatment of erectile dysfunction in hypertensive men taking concomitant antihypertensive agents.     

The diagnostic value of the premature ejaculation diagnostic tool and its association with intravaginal ejaculatory latency time

IntroductionPremature ejaculation (PE) is the most prevalent male ejaculation disorder. The premature ejaculation diagnostic tool (PEDT) was developed to systematically apply the DSM‐IV‐TR criteria in diagnostic PE.AimsTo evaluate the diagnostic value of the PEDT and its association with intravaginal ejaculatory latency time (IELT).Methods(i) Korean validation of PEDT: data was collected from men interviewed by one of the two clinical experts, who made a diagnostic of present or absence of PE, using DSM‐IV‐TR criteria. A total of 103 patients with PE and 100 men without PE were enrolled into the study and requested to complete the PEDT; and (ii) The correlation between IELT and PEDT: 200 participants were enrolled and each participant was asked to make out PEDT. All participants were requested to measure IELT.Main Outcome MeasuresValidity and reliability of the PEDT and its association with IELT.ResultsThe geometric mean IELT of the PE group was 115.37 ± 78.14 seconds. The number of men reporting IELTs of <1, 1 to ≤2, and >2 minutes were 28 (28.6%), 29 (29.6%), and 41 (41.8%), respectively. The Cronbach's alpha score was calculated as 0.93, showing adequate internal consistency. The test–retest correlation coefficients of each item were higher than 0.72 and the correlation coefficients of the total score was 0.88. (P < 0.001) Sensitivity and specificity analyses suggested a score of ≤8 indicated no PE, 9 and 10 probable PE, and ≥11 PE. The PEDT total score and IELT showed an adequate negative correlation. (ρ = ?0.77, P < 0.0001) also, the PEDT total score of the PE subgroup (IELT ≤ 2 minutes) and IELT showed a negative correlation. (ρ = ?0.6, P < 0.0001)ConclusionsThe PEDT was highly effective in detecting the presence of PE. The result of our study supports its validity as a diagnostic tool in the clinical setting. Kam SC, Han DH, and Lee SW. The diagnostic value of the premature ejaculation diagnostic tool and its association with intravaginal ejaculatory latency time. J Sex Med 2011;8:865–871.     

The Premature Ejaculation Diagnostic Tool (PEDT): Linguistic Validity of the Chinese Version

IntroductionThe premature ejaculation diagnostic tool (PEDT) was developed to standardize the diagnosis of PE and has been applied in many countries. However, a linguistic validation of the Chinese version of PEDT does not exist.AimsThis study aims to undertake the Chinese validation of the PEDT and to evaluate its association with self‐estimated intravaginal ejaculatory latency time (IELT) and clinical expert diagnosis of PE.MethodsA Chinese version of PEDT was confirmed by andrologist and bilingual linguist. Participants were recruited among seven different communities of Shanghai from 2011 to 2012, and their information regarding self‐reported PE, self‐estimated IELT, expert diagnosis of PE, and PEDT scores were collected.Main Outcome MeasuresValidity of the PEDT and its association with clinical expert diagnosis of PE and self‐estimated IELT were analyzed.ResultsA total of 143 patients without PE (mean age 55.11 ± 7.65 years) and 100 men with PE (mean age 53.07 ± 8.08 years) were enrolled for validation. Of the patients in PE group, the number of men reporting self‐estimated IELTs of ≤1, 1–2, and >2 minutes were 34 (34.0%), 22 (22.0%), and 44 (44.0%), respectively. The Cronbach's alpha score (α = 0.77) showed adequate internal consistency, and the test–retest correlation coefficients of each item (r ≥ 0.70, P < 0.001) indicated excellent stability over time. The frequency of agreement showed that there was excellent concordance between PEDT diagnosis and clinician diagnosis when the PEDT scores ≥11. An adequate correlation was found between total PEDT score and self‐estimated IELT (ρ = −0.396, P < 0.001), and sensitivity and specificity analyses suggested a score of ≤8 indicated no time‐defined PE (self‐estimated IELT ≤1 minute).ConclusionsThe Chinese version of PEDT is valid in screening the presence of PE among Chinese men. The PEDT showed an adequate negative correlation with self‐estimated IELT and an excellent concordance with clinician diagnosis of PE. Huang Y‐P, Chen B, Ping P, Wang H‐X, Hu K, Zhang T, Yang H, Jin Y, Yang Q, and Huang Y‐R. The premature ejaculation diagnostic tool (PEDT): Linguistic validity of the Chinese version. J Sex Med 2014;11:2232‐2238.     

The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer

IntroductionThe relationship between erectile dysfunction (ED) and depressive symptoms is well established. However, this relationship is not well explored in men with prostate cancer. Limited data suggest men with prostate cancer may experience less ED bother than men with ED who do not have prostate cancer, implying that ED and depressive symptoms may not be associated in men with prostate cancer.AimTo determine if ED is associated with depressive symptoms in men with prostate cancer.Main Outcome MeasuresAssessments of quality‐of‐life (The Functional Assessment of Cancer Therapy [FACT‐P]), anxiety/depression (Hospital Anxiety and Depression Scale [HADS]), and erectile function. Erectile function was measured with one question from the FACT‐P similar to that used by the Massachusetts Male Aging Study.MethodsMen with prostate cancer, and naïve of hormone treatment, completed the study questionnaires at a single time point.ResultsThe average age of the 339 men was 67 ± 10 years. The average time since diagnosis was 3.9 ± 3 years. When answering the question, “I am able to have and maintain an erection” on a 1 to 5 scale (5 representing the best function), the mean score was 2 indicating “a little bit.” On univariate analysis, erectile function and depression were associated, r = ?0.12, P < 0.05. Other variables associated with depression were marital status, r = 0.11, P < 0.05; anxiety scores, r = 0.56, P < 0.01; and social support, r = ?0.42, P < 0.01. On multivariate analysis, erectile function remained a significant predictor of depression, beta = ?0.10, P < 0.05.ConclusionsErectile function was associated with depressive symptoms in both univariate and multivariate analysis, indicating that ED is independently associated with depressive symptoms even though patients were approximately 4 years post diagnosis. These cross‐sectional data suggest ED in men with prostate cancer can have lasting psychological effects. Nelson CJ, Mulhall JP, and Roth AJ. The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer. J Sex Med 2011;8:560–566.     

A Prospective Study on Association of Prostatic Calcifications with Sexual Dysfunction in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

IntroductionChronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common debilitating condition of unclear etiology. Sexual dysfunction is an important component of the clinical phenotype of CP/CPPS. Patients often have prostatic calcifications, but a link to sexual dysfunction is unknown.AimThe aim of this study was to evaluate the association of prostatic calcifications with sexual dysfunction in this condition.MethodsA total of 358 males with CP/CPPS were consecutively enrolled, and a prospectively maintained database of these patients was analyzed. Calcifications were diagnosed using ultrasound imaging of the prostate. Symptom severity was measured using the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). Sexual dysfunction was evaluated using the validated 15‐item International Index of Erectile Function (IIEF‐15) questionnaire and 5‐item Premature Ejaculation Diagnostic Tool scales. The variables were compared between patients with prostatic calcifications and those without using the Student's t‐test, Wilcoxon unpaired test, or chi‐square test.Main Outcome MeasureLogistic regression models were developed to explore a possible association between prostatic calcifications and sexual dysfunction.ResultsMeasurable calcifications in the prostate were found in 175 (48.9%) of the 358 patients. Patients with calcifications were more likely to have higher white blood cell counts or positive bacteria cultures in their prostatic fluid, longer symptoms duration, and lower scores for the total IIEF‐15, IIEF‐erectile function, and IIEF‐intercourse satisfaction domains (P < 0.001 for each). However, the scores for CPSI, premature ejaculation, and IIEF‐orgasmic function, IIEF‐sexual desire, and IIEF‐overall satisfaction domains were identical between men with and without calcifications (P > 0.05 for each). Furthermore, logistic regression analyses revealed that intraprostatic calcification is significantly associated with self‐assessed erectile dysfunction (ED) (odds ratio:3.632, 95% confidence interval: 2.405–5.822, P < 0.001).ConclusionOur results showed that prostatic calcifications are significantly associated with the presence of ED in CP/CPPS males. Zhao Z, Xuan X, Zhang J, He J, and Zeng G. A prospective study on association of prostatic calcifications with sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). J Sex Med 2014;11:2528–2536.     

Interplay Between Premature Ejaculation and Erectile Dysfunction: A Systematic Review and Meta‐Analysis

IntroductionThe specific determinants and underlying factors linking erectile dysfunction (ED) and premature ejaculation (PE) have yet to be clearly identified.AimThe aim of this study was to review and meta‐analyze all available data regarding the link between ED and PE.MethodsAn extensive Medline Embase and Cochrane search was performed including the following words: “premature ejaculation” and “erectile dysfunction”.Main Outcome MeasuresAll observational trials comparing the risk of ED in relation to PE were included. Data extraction was performed independently by two of the authors (G.R, G.C.), and conflicts resolved by the third investigator (M.M.).ResultsOut of 474 retrieved articles, 18 were included in the study for a total of 57,229 patients, of which 12,144 (21.2%) had PE. The presence of PE, however defined, was associated with a significant increase in ED risk (odds ratio: 3.68[2.61;5.18]; P < 0.0001). Meta‐regression analysis showed that the risk of ED in PE subjects was higher in older individuals as well as in those with a lower level of education and in those who reported a stable relationship less frequently. In addition, subjects with PE and ED more often reported anxiety and depressive symptoms and a lower prevalence of organic associated morbidities, including diabetes mellitus, hypertension and dyslipidemia. All the latter associations were confirmed even after adjustment for age. Finally the risk of PE‐related ED increased with the increased proportion of acquired ejaculatory problems (adj r = 0.414; P < 0.0001 after the adjustment for age).ConclusionsIn conclusion, the present data showed that ED and PE are not distinctly separate entities, but should be considered from a dimensional point of view. Understanding this dimensional perspective might help sexual health care professionals in providing the most appropriate therapeutic approach to realistically increase patient related outcomes in sexual medicine. Corona G, Rastrelli G, Limoncin E, Sforza A, Jannini EA, and Maggi M. The interplay between premature ejaculation and erectile dysfunction: A systematic review and meta‐analysis. J Sex Med 2015;12:2291–2300.     

Prevalence and correlates of premature ejaculation in a primary care setting: a preliminary cross-sectional study

IntroductionPremature ejaculation (PE) is common. However, it has been underreported and undertreated.AimsTo determine the prevalence of PE and to investigate possible associated factors of PE.MethodsThis cross‐sectional study was conducted at a primary care clinic over a 3‐month period in 2008. Men aged 18–70 years attending the clinic were recruited, and they completed self‐administered questionnaires that included the Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function, sociodemography, lifestyle, and medical illness. The operational definition of PE included PE and probable PE based on the PEDT.Main Outcome MeasurePrevalence of PE.ResultsA total of 207 men were recruited with a response rate of 93.2%. There were 97 (46.9%) Malay, 57 (27.5%) Chinese, and 53 (25.6%) Indian, and their mean age was 46.0 ± 12.7 years. The prevalence of PE was 40.6% (N = 82) (PE: 20.3%, probable PE: 20.3% using PEDT). A significant association was found between ethnicity and PE (Indian 49.1%, Malay 45.4%, and Chinese 24.6%; χ² = 8.564, d.f. = 2, P = 0.014). No significant association was found between age and PE. Multivariate analysis showed that erectile dysfunction (adjusted odds ratio [OR] 4.907, 95% confidence interval [CI] 2.271, 10.604), circumcision (adjusted OR 4.881, 95% CI 2.346, 10.153), sexual intercourse ≤5 times in 4 weeks (adjusted OR 3.733, 95% CI 1.847, 7.544), and Indian ethnicity (adjusted OR 3.323, 95% CI 1.489, 7.417) were predictors of PE.ConclusionPE might be frequent in men attending primary care clinics. We found that erectile dysfunction, circumcision, Indian ethnicity, and frequency of sexual intercourse of ≤5 times per month were associated with PE. These associations need further confirmation. Tang WS and Khoo EM. Prevalence and correlates of premature ejaculation in a primary care setting: A preliminary cross‐sectional study. J Sex Med 2011;8:2071–2078.     

A Return to Normal Erectile Function with Tadalafil Once Daily after an Incomplete Response to As‐Needed PDE5 Inhibitor Therapy

IntroductionAn optimal outcome of an erectile dysfunction (ED) treatment is to enable a return to normal erectile function (as defined by an International Index of Erectile Function—Erectile Function [IIEF‐EF] domain score ≥26). As‐needed (PRN) phosphodiesterase type 5 (PDE5) inhibitor treatment does not always result in a return‐to‐normal erectile function.AimThe combined studies evaluated whether treatment with tadalafil once daily would allow men to return to normal erectile function who had less than normal IIEF‐EF domain scores while using a maximum dose of a PRN PDE5 inhibitor treatment.MethodsMen were ≥18 years of age, sexually active, reported a ≥3‐month history of ED, and had been taking the maximum dose of sildenafil citrate, vardenafil, or tadalafil PRN. Randomization to once‐daily therapy with tadalafil 2.5 mg to 5 mg (N = 207), tadalafil 5 mg (N = 207), or placebo (N = 209) for 12 weeks followed a 4‐week maximum dose PRN PDE5 treatment and 4‐week nondrug lead periods. Two identical double‐blind, randomized, placebo‐controlled studies were conducted; combined results are reported.Main Outcome MeasureThe main outcome measure was the percentage of subjects with a return‐to‐normal erectile function (IIEF‐EF domain score ≥ 26) when treated with tadalafil once daily compared with placebo.ResultsIn subjects not achieving normal erectile function with the maximum dose of a PRN PDE5 inhibitor, a higher percentage of subjects treated with tadalafil had an IIEF‐EF domain score ≥26 at end point (tadalafil 2.5‐ to 5‐mg group [39%]; tadalafil 5‐mg group [40%]) compared with the placebo group (12.1%; P < 0.001). Tadalafil was generally well tolerated and adverse events observed were consistent with previous reports of tadalafil once daily.ConclusionsTreatment with tadalafil once daily significantly improved erectile function in men with mild to mild‐moderate impairments in erectile function following PRN PDE5 inhibitor treatment. Kim ED, Seftel AD, Goldfischer ER, Ni X, and Burns PR. A return to normal erectile function with tadalafil once daily after an incomplete response to as‐needed PDE5 inhibitor therapy. J Sex Med 2014;11:820–830.     

Clinical Parameters that Predict Successful Outcome in Men with Premature Ejaculation and Inflammatory Prostatitis

IntroductionPremature ejaculation (PE) is the most common sexual problem, and chronic prostatitis is an important cause of PE.AimThe aim of this study was to determine which clinical parameters predict successful outcomes following treatment of men with PE and chronic prostatitis (category II and IIIa).Main Outcome MeasureChange in intravaginal ejaculatory latency time (IELT) and its relation to different clinical parameters.MethodsThis study included 210 heterosexual men with PE and inflammatory prostatitis. PE was found to be acquired in 155 men (A‐PE) and lifelong in 55 (LL‐PE). All participants were asked to complete the National Institutes of Health‐Chronic Prostatitis Symptom Index (NIH‐CPSI). Sequential microbiologic specimens were obtained. Antibiotics were given to 184 men for 4 weeks, guided by sensitivity tests. Twenty‐six men refused or did not comply with the antimicrobial therapy and were used as the untreated group. Clinical reevaluation was conducted after 28 days.ResultsTwo of the 26 men (7.7%) from the untreated group experienced an increase in their ejaculatory latency compared with 109 of the184 men (59.0%) who received antimicrobial therapy (P = 0.0001). After treatment, 90 of 155 men (58.0%) with A‐PE reported ILET > 2 minutes compared with 21 of 55 men (38.2%) with LL‐PE (P = 0.012). Based on a receiver operating characteristic curve, antimicrobial therapy is most effective if there are ≥19 pus cells per high‐power field (HPF) in the expressed prostatic secretion (EPS) analysis, with a sensitivity of 85.6% and a specificity of 70.7% (area under the curve 0.783, 95% CI 0.716–0.850). Other clinical parameters were not useful in predicting outcomes.ConclusionsAntimicrobial therapy is useful in the treatment of PE associated with inflammatory prostatitis. The treatment is most effective in men with A‐PE and when there are ≥19 pus cells per HPF in an EPS analysis. Zohdy W. Clinical parameters that predict successful outcome in men with premature ejaculation and inflammatory prostatitis.     

Independent Association of Erectile Dysfunction and Low Testosterone Levels With Life Dissatisfaction in Men With Chronic Spinal Cord Injury

BackgroundThe loss of global functional independence, along with bladder, bowel, and sexual dysfunctions, may contribute to psychological distress and life dissatisfaction after spinal cord injury (SCI).AimTo explore the relationship of erectile function and androgenic status with life satisfaction, independently from confounders recognizable in spinal cord–injured men.Methods100 consecutive men (49 ± 17 years) admitted to a rehabilitation program because of chronic SCI (≥1 year) underwent clinical/biochemical evaluations, including the assessment of life and sexual satisfaction using the Life-Satisfaction Questionnaire-9 (LiSat-9), erectile function using the International Index of Erectile Function-5 (IIEF-5), global and bowel-bladder functional independence using the Spinal Cord Independence Measure (SCIM) and measurement of total testosterone (TT) levels. The free testosterone level was calculated using the Vermeulen formula.OutcomesThe outcomes include the relationship between sexual health and life satisfaction in men with SCI.ResultsA LiSat-9 score <4, suggestive for life dissatisfaction, was exhibited by 49% of men. When compared with the life-satisfied group, a significantly higher percentage of them had sexual dissatisfaction and erectile dysfunction (ED); they also exhibited significantly lower levels of TT and calculated free testosterone (cFT) and a more severe impairment of bowel-bladder function. The life satisfaction degree correlated with sexual satisfaction degree, IIEF-5 score, TT, cFT, and bowel-bladder function degree. At the logistic regression model, including sexual LiSat-9 subscore and bowel-bladder SCIM subscore, only the former exhibited a significant negative association with life dissatisfaction. In a further logistic regression model, including the putative key determinants of sexual satisfaction, erectile function, and cFT levels, a higher odd of life dissatisfaction was independently associated both with a lower IIEF-5 score (OR: 0.93; 95% CI: 0.88, 0.98) and lower cFT levels (OR: 0.98; 95% CI: 0.98, 0.99).Clinical ImplicationsIn men with chronic SCI, assessment of erectile function and testosterone levels can help to predict life satisfaction.Strengths & LimitationsThis is the first demonstration of the independent association of androgen deficiency and ED with life satisfaction in men with SCI. Prospective studies are warranted to clarify the cause-effect relationships.ConclusionsIn men with SCI, ED and low testosterone levels exhibit a significant independent association with life dissatisfaction; longitudinal intervention studies could explore possible effects of their treatment in improving sexual and life satisfaction in this population.D'Andrea S, Minaldi E, Castellini C, et al. Independent Association of Erectile Dysfunction and Low Testosterone Levels With Life Dissatisfaction in Men With Chronic Spinal Cord Injury. J Sex Med 2020;17:911–918.     

SIEDY Scale 3, a New Instrument to Detect Psychological Component in Subjects with Erectile Dysfunction

IntroductionWe previously developed and validated a structured interview (SIEDY) dealing with the organic (Scale 1), relational (Scale 2), and psychological (Scale 3) components of erectile dysfunction (ED).AimTo identify a pathological threshold for SIEDY Scale 3 and to analyze Scale 3 score with biological and psychological correlates in subjects with sexual dysfunction.MethodA pathological threshold of SIEDY Scale 3 score in predicting subjects with a medical history of psychopathology and using psychiatric drugs was identified through receiver operating characteristic (ROC) curve analysis in a sample of 484 patients (Sample A).Main Outcome MeasureSensitivity and specificity, along with possible interactions with biological and psychological (Middlesex Hospital Questionnaire, MHQ‐score) correlates were verified in a further sample of 1,275 patients (Sample B).ResultsIn sample A, 39 (8%) and 60 (12.4%) subjects reported a positive medical history for psychiatric disturbances or for the use of psychotropic medication, respectively. The association with both conditions was present in 28 (5.8%) subjects. ROC curve showed that SIEDY Scale 3 score predicts psychopathology with an accuracy of 69.5 ± 5.9% (P < 0.002), when a threshold of 3 was chosen. When the same threshold was applied in Sample B, it identified a higher ranking in MHQ‐A (free‐floating anxiety), MHQ‐S (somatized anxiety) and MHQ‐D (depressive symptoms) subscales, even after adjustment for age and Σ‐MHQ (a broader index of general psychopathology). In the same sample, we also confirmed that pathological Scale 3 score was related to a higher risk of psychopathology at medical history or to the use of psychotropic drugs as well as with risky lifestyle behaviors, including smoking and alcohol abuse, and elevated BMI.ConclusionsSIEDY represents an easy tool for the identification of patients with a relevant intra‐psychic component who should be considered for psychological/psychiatric treatment. Corona G, Ricca V, Bandini E, Rastrelli G, Casale H, Jannini EA, Sforza A, Forti G, Mannucci E, and Maggi M. SIEDY Scale 3, a new instrument to detect psychological component in subjects with erectile dysfunction. J Sex Med 2012;9:2017–2026.     

A therapeutic confirmatory study to assess the safety and efficacy of Zydena (udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus

IntroductionPatients with diabetes mellitus (DM) are reported to experience more severe erectile dysfunction (ED) symptoms and respond less to ED treatments compared with patients with ED of other etiologies.AimThis study was undertaken to evaluate the safety and efficacy of udenafil for the treatment of ED in a larger number of patients with DM.MethodsA placebo‐controlled, randomized, double‐blind, double‐dummy, parallel‐group design multicenter study, fixed‐dose trial was conducted. The trial involved seven study sites in Korea, with 174 ED patients with DM. The subjects, treated with placebo, 100 mg, or 200 mg of udenafil for 12 weeks, were asked to complete the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary, and the Global Assessment Question (GAQ) during the study period.Main Outcome MeasuresThe primary efficacy parameter was the change in the erectile function domain (EFD) score of IIEF from baseline. Secondary parameters were IIEF questions 3 (Q3) and Q4, SEP Q2 and Q3, rate of achieving normal erectile function (EFD ≥ 26), and the response to GAQ.ResultsCompared with the placebo, patients receiving both doses of udenafil showed statistically significant improvements in the IIEF‐EFD score, respectively. However, statistically significant difference was not observed between the udenafil 100 mg and the udenafil 200 mg groups. Similar results were observed in the comparison of Q3 and Q4 of IIEF, SEP diary, and GAQ. The percentages of subjects experiencing at least one adverse event related to the study drugs were 3.6%, 15.8%, and 22.4% for the placebo, udenafil 100 mg, and udenafil 200 mg groups, respectively. However, these events were all mild in severity. Major adverse events were flushing, headache, nausea, and conjunctival hyperemia.ConclusionUdenafil was significantly effective for the treatment of ED, demonstrating statistically significant improvement in erectile function in patients with DM. The incidence of adverse events was relatively low and well tolerated in patients with DM. Moon DG, Yang DY, Lee CH, Ahn TY, Min KS, Park K, Park CK, and Kim JJ. A therapeutic confirmatory study to assess the safety and efficacy of Zydena^® (udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus. J Sex Med 2011;8:2048–2061.