Clinical Correlates of Erectile Dysfunction and Premature Ejaculation in Men with Couple Infertility

IntroductionThe frequency and the clinical characteristics of erectile dysfunction (ED) and premature ejaculation (PE) in infertile men have been poorly investigated.AimTo assess the prevalence of ED and PE and their clinical correlates in men seeking medical care for couple infertility.MethodsA consecutive series of 244 men (mean age 35.2 ± 7.8) with couple infertility was systematically evaluated. Erectile function was investigated with the International Index of Erectile Function‐15 erectile function domain (IIEF‐15‐EFD) whereas ejaculatory status with the PE diagnostic tool (PEDT).Main Outcome MeasuresAll patients underwent psychological (Middlesex Hospital Questionnaire [MHQ]), prostatitis symptoms (National Institutes of Health–chronic prostatitis symptom index [NIH‐CPSI]); hormonal, seminal, and interleukin 8 (sIL‐8; a surrogate marker of prostatitis) evaluation; along with scrotal and transrectal color Doppler ultrasound (CDU) assessment.ResultsED was found in 43 (17.8%) and PE in 38 (15.6%) subjects. After adjusting for age, IIEF‐15‐EFD score was negatively associated with depressive symptoms (MHQ‐D score), somatization (MHQ‐S score), NIH‐CPSI total, and quality of life subdomain score. In a logistic multivariate model, among all these variables, only depression was significantly associated with ED (adjusted odds ratio [OR] = 1.19 [1.02–1.39]; P < 0.05). PEDT score was positively associated with prostatitis symptoms and signs, such as sIL‐8 and prostate CDU abnormalities (including arterial prostatic peak systolic velocity, APPSV), phobic anxiety (MHQ‐P score), and calculated free testosterone (cFT). The association between PE and NIH‐CPSI score or APPSV was confirmed even after adjustment for age, MHQ‐P score and cFT (adjusted OR = 1.11 [1.05–1.17]; P < 0.0001 and 1.22 [1.03–1.44]; P = 0.02, for NIH‐CPSI score and APPSV, respectively).ConclusionsED and PE are reported by one in six infertile patients. ED is mainly associated with depressive symptoms, while PEDT score is positively associated with prostatitis symptoms and signs, phobic anxiety, and cFT. Lotti F, Corona G, Rastrelli G, Forti G, Jannini EA, and Maggi M. Clinical correlates of erectile dysfunction and premature ejaculation in men with couple infertility. J Sex Med **;**:**–**.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Predictors of sexual and relationship functioning in couples with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

IntroductionBoth partners in a relationship are typically affected when one experiences sexual dysfunction and/or pain. However, couple functioning has rarely been investigated in Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS), a common condition in men involving pelvic pain and sexual dysfunction.AimTo identify potential predictors of sexual and relationship function among couples with CP/CPPS, and to examine associations among pain, sexual, and relationship variables in patients and their women partners.MethodsThirty-eight patients with CP/CPPS and their women partners completed questionnaires assessing sexual and relationship function via mail.Main Outcome MeasuresPatients completed a subscale from the Multidimensional Pain Inventory and the International Index of Erectile Function. Partners completed the Female Sexual Function Index. All participants completed the Golombok–Rust Inventory of Sexual Satisfaction and the Dyadic Adjustment Scale.ResultsCouples' sexual function, sexual satisfaction, and relationship adjustment were all significantly associated. Pain severity significantly predicted sexual and relationship functioning among couples. However, multiple regression models revealed that sexual and relationship variables were the strongest predictors of patient and partner functioning, over and above pain severity. Patient sexual function was predicted by patient sexual satisfaction and female sexual function, whereas female sexual function was predicted by female sexual satisfaction and patient relationship adjustment. With regard to sexual satisfaction, patient sexual function and relationship adjustment and female relationship adjustment predicted patient sexual satisfaction. Female sexual function predicted female sexual satisfaction. Among both patients and partners, relationship adjustment was significantly predicted by that of one's partner. The only partner variable that was significantly predicted by patient pain severity was female sexual function.ConclusionsSignificant links exist among the sexual and relationship functioning of patients with CP/CPPS and their partners. These results emphasize the importance of the interpersonal context on couples' functioning, and highlight the need to adopt a biopsychosocial approach when investigating CP/CPPS. Smith KB, Tripp D, Pukall C, and Nickel JC. Predictors of sexual and relationship functioning in couples with Chronic Prostatitis/Chronic Pelvic Pain Syndrome.     

Predictors of Male Sexual Dysfunction in Urologic Chronic Pelvic Pain Syndrome (UCPPS), Other Chronic Pain Syndromes,and Healthy Controls in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

BackgroundSexual dysfunction (SD), including erectile (ED) and ejaculatory dysfunction, is associated with diminished quality of life (QoL) in men with UCPPS (chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and/or interstitial cystitis/bladder pain syndrome (IC/BPS)).AimWe sought to compare SD among male patients with UCPPS, other chronic pain conditions (positive controls, PC), and healthy controls (HC) without chronic pain, and to evaluate the association of comorbidities, psychosocial factors, and urologic factors of SD in all 3 groups.MethodsBaseline data from male UCPPS participants, PC (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia) and HC enrolled in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Epidemiology and Phenotyping Study were included in the analysis. Sexual function was assessed using the International Index of Erectile Function-Erectile Function Domain (IIEFEF) and Ejaculatory Function Scale (EFS). Male ED was defined as a composite IIEF-EF score <21. Higher EFS score indicated worse sexual dysfunction; no threshold to define SD was identified for the EFS. Multivariable logistic and linear regression was used to investigate associations of comorbidities, psychosocial factors, and urologic factors with ED and ejaculatory, respectively.OutcomesComorbidities, genital pain, and psychosocial factors are associated with SD across the study population and male patients with UCPPS had a high prevalence of ED and greater ejaculatory dysfunction.ResultsThere were 191 males with UCPPS; 44 PC; and 182 HC. Males with UCPPS had worse SD compared to PC and HC including lower mean IIEF-EF scores, greater degree of ejaculatory dysfunction, and lower quality of sexual relationships. Among all 3 cohorts, depression, stress, and pain were associated with ED in univariable and multivariable analysis, as was diabetes mellitus. Pain in the genitalia, severity of urinary symptoms, depression, stress, and history of childhood sexual trauma were associated with ejaculatory dysfunction in univariable and multivariable analysis.Clinical ImplicationsA multidisciplinary approach that addresses the identified risk factors for SD may improve overall QoL in males with UCPPS.Strengths and LimitationsOur study is strengthened by its use of validated, patient-reported questionnaires and inclusion of healthy and positive controls. Our understanding of the role of IC in this study is limited because only 1 patient in the study had IC/BPS as a sole diagnosis.ConclusionsWhen compared to healthy controls and patients with other chronic pain conditions, males with UCPPS experience higher degrees of SD, including erectile and ejaculatory dysfunction.Loh-Doyle JC, Stephens-Shields AJ, Rolston R, et al. Predictors of Male Sexual Dysfunction in Urologic Chronic Pelvic Pain Syndrome (UCPPS), Other Chronic Pain Syndromes, and Healthy Controls in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. J Sex Med 2022;19:1804–1812.     

Combined Testosterone and Vardenafil Treatment for Restoring Erectile Function in Hypogonadal Patients who Failed to Respond to Testosterone Therapy Alone

IntroductionThe role of testosterone in erectile dysfunction (ED) is increasingly recognized. It is suggested that assessment of testosterone deficiency in men with ED and symptoms of hypogonadism, prior to first‐line treatment, may be a useful tool for improving therapy.AimIn this prospective, observational, and longitudinal study, we investigated the effects of vardenafil treatment as adjunctive therapy to testosterone undecanoate in hypogonadal ED patients who failed to respond to testosterone treatment alone.MethodsOne hundred twenty‐nine testosterone deficient (serum total testosterone ≤3.4 ng/mL) patients aged 56 ± 3.9 years received intramuscular injections of long‐acting parenteral testosterone undecanoate at 3‐month intervals for 8 months mean follow‐up.Main Outcome MeasuresScores on the International Index of Erectile Function Questionnaire‐five items (IIEF‐5) and partner survey scores were compared at baseline and posttreatment with testosterone therapy alone or in combination with vardenafil. Patient baseline demographics and concomitant disease were correlated with patients' IIEF‐5 scores.ResultsSeventy one (58.2%) responded well to monotherapy within 3 months. Nonresponders had lower testosterone levels and higher rates of concomitant diseases and smoking. Thirty‐four of the 51 nonresponders accepted the addition of 20 mg vardenafil on demand. Efficacy assessments were measured by the IIEF–erectile function domain (IIEF‐EF, questions 1–5 plus 15, 30 points) and partner self‐designed survey at baseline after 4–6 weeks and at study end point. Thirty out of 34 patients responded well to this combination. IIEF‐EF Sexual Health Inventory for Men score improved from 12 to 24 (P < 0.0001), and partner survey showed significantly higher satisfaction (P < 0.001). These patients reported spontaneous or nocturnal and morning erections or tumescence. No changes in adverse effects were recorded.ConclusionsThese data suggest that combination therapy of testosterone and vardenafil is safe and effective in treating hypogonadal ED patients who failed to respond to testosterone monotherapy. Yassin D‐J, Yassin AA, and Hammerer PG. Combined testosterone and vardenafil treatment for restoring erectile function in hypogonadal patients who failed to respond to testosterone therapy alone. J Sex Med 2014;11:543–552.     

Influence of Androgen Receptor CAG Polymorphism on Sexual Function Recovery after Testosterone Therapy in Late‐Onset Hypogonadism

IntroductionAndrogen receptor (AR) CAG polymorphism has been found to influence sexual function. However, no study has evaluated its potential to condition sexual function recovery after testosterone replacement therapy (TRT) in a large cohort of hypogonadic subjects.AimTo evaluate the role of this polymorphism in sexual function improvement after TRT in late‐onset hypogonadism (LOH).MethodsSeventy‐three men affected by LOH were retrospectively considered. Evaluations were performed before TRT started (time 0) and before the sixth undecanoate testosterone injection.Main Outcome MeasuresInternational Index of Erectile Function (IIEF) questionnaire (erectile function [EF], orgasmic function [OF], sexual desire [SD], intercourse satisfaction [IS], overall satisfaction [OS], and total IIEF‐15 score); total and free testosterone and estradiol; AR gene CAG repeat number.ResultsTRT induced a significant increase in total and free testosterone and estradiol. All IIEF domains significantly improved after TRT. AR CAG repeats negatively and significantly correlated with all the variations (Δ‐) of sexual function domains, except for Δ‐OS. Conversely, Δ‐total testosterone was found to be positively and significantly correlated with sexual function domain variations, except for Δ‐IS and Δ‐OS. Δ‐estradiol did not correlate significantly with any of the variations of sexual function domains. After inclusion in generalized linear models, the number of AR gene CAG triplets was found to be independently and negatively associated with Δ‐EF, Δ‐SD, Δ‐IS, and Δ‐Total IIEF‐15 score, whereas Δ‐total testosterone was independently and positively associated with Δ‐EF, Δ‐OF, Δ‐SD, and Δ‐Total IIEF‐15 score. However, after including time 0 total testosterone in the model, AR gene CAG triplets remained independently and negatively associated only with Δ‐EF and Δ‐Total IIEF‐15 score, whereas Δ‐total testosterone was independently and positively associated only with Δ‐EF.ConclusionsLonger length of AR gene CAG repeat tract seems to lower TRT‐induced improvement of sexual function in LOH. Tirabassi G, Corona G, Biagioli A, Buldreghini E, delli Muti N, Maggi M, and Balercia G. Influence of androgen receptor CAG polymorphism on sexual function recovery after testosterone therapy in late‐onset hypogonadism. J Sex Med 2015;12:381–388.     

Low-Intensity Shock Wave Therapy in Sexual Medicine—Clinical Recommendations from the European Society of Sexual Medicine (ESSM)

IntroductionLow-intensity shockwave therapy (LISWT) has been investigated for the treatment of uroandrological disorders including erectile dysfunction (ED), Peyronie’s disease (PD) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with controversial findings.AimTo review the evidence on LISWT for ED, PD, and CP/CPPS and provide clinical recommendations on behalf of the European Society of Sexual Medicine.MethodsMedline and Embase databases were searched for randomized clinical trials (RCTs), meta-analyses and open-label prospective or retrospective studies investigating the effect of LISWT on ED, PD, or CP/CPPS.OutcomesThe panel provided statements on clinically relevant questions concerning LISWT: (i) treatment efficacy, (ii) treatment protocol, (iii) clinical indications, and (iv) safety. The level of evidence was provided according to the Oxford 2011 criteria and graded using the Oxford Centre for Evidence-Based Medicine recommendations.Results11 RCTs and 5 meta-analyses investigated LISWT for ED. RCTs provided controversial results on the efficacy of LISWT and were affected by high heterogeneity and the small number of patients included. Pooled-data analysis showed an overall positive effect in terms of erectile function improvement but reported small estimates and included a largely heterogeneous cohort of patients. 4 RCTs and 1 meta-analysis assessed LISWT for PD. All trials showed positive findings in terms of pain relief but no effect on penile curvature and plaque size. Inclusion criteria vary widely among studies, and further investigation is needed. 5 RCTs investigated LISWT for CP/CPPS. Data showed a possible effect on pain relief, although there is no evidence supporting that pain relief was maintained or any improvement in pain over time.Clinical ImplicationsLISWT needs to be further investigated in the context of sexual medicine and is almost but not yet ready for clinical practice.Strengths and limitationsAll studies have been evaluated by a panel of experts providing recommendations for clinical practice.ConclusionsLISWT is a safe and well-tolerated procedure but its efficacy for the treatment of ED is doubtful and deserves more investigation. Patients reporting pain associated with PD may benefit from LISWT, although no effect is expected on disease progression. LISWT is not a primary treatment for CP/CPPS, but it may be considered as an option to relieve pain.Capogrosso P, Frey A, Jensen CFS, et al. Low-Intensity Shock Wave Therapy in Sexual Medicine—Clinical Recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1490–1505.     

The Impact of Intravaginal Ejaculatory Latency Time and Erectile Function on Anxiety and Depression in the Four Types of Premature Ejaculation: A Large Cross‐Sectional Study in a Chinese Population

IntroductionA new classification of premature ejaculation (PE) has been proposed, including the categories of lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), and premature‐like ejaculatory dysfunction (PLED).AimThe aim of this study was to evaluate the impact of intravaginal ejaculation latency time (IELT) and erectile function on anxiety and depression among patients with PE in general and according to the four types of PE.MethodsBetween September 2011 and September 2012, we conducted a cross‐sectional study in the Anhui province of China. We enrolled 4,000 men aged over 18 years, each of whom had been in a stable, monogamous, heterosexual relationship with the same partner for at least 6 months.Main Outcome MeasurementsSelf‐estimated IELT, the International Index of Erectile Function‐5 (IIEF‐5) and the Zung Self‐Rating Anxiety and Depression Scales (SAS/SDS) were used to measure PE, erectile dysfunction (ED), anxiety, and depression, respectively, among the entire study population.ResultsOf the 3,016 men evaluated, 25.80% complained of PE. Distribution of the four types of PE among men with PE was as follows: LPE, 12.34%; APE, 18.77%; NVPE, 44.09%; PLED, 24.81%. Men with PE presented lower IIEF‐5 scores and higher SAS and SDS scores vs. men without PE (P < 0.001 for all). Similar findings were observed in men with APE when compared with other PE syndromes. After adjustment for age in men with PE, IELT was negatively associated with SAS and SDS scores (SAS, adjusted r = −0.42, P < 0.001; SDS, adjusted r = −0.45, P < 0.001). IIEF‐5 score was negatively associated with SAS and SDS scores (SAS, adjusted r = −0.54, P < 0.001; SDS, adjusted r = −0.50, P < 0.001). These negative relationships were strongest in men with PLED (IELT vs. SAS: adjusted r = −0.63, P < 0.001; IELT vs. SDS, adjusted r = −0.60, P < 0.001; IIEF‐5 vs. SAS: adjusted r = −0.57, P < 0.001; IELT vs. SDS, adjusted r = −0.55, P < 0.001).ConclusionsAPE patients reported higher rates of ED, anxiety, and depression than men with other types of PE. The negative relationships between IELT/IIEF‐5 and SAS/SDS were strongest in men with PLED. Gao J, Zhang X, Su P, Peng Z, Liu J, Xia L, Lu Z, Yang J, Tang D, Gao P, Zhou J, Hao Z, and Liang C. The impact of intravaginal ejaculatory latency time and erectile function on anxiety and depression in the four types of premature ejaculation: A large cross‐sectional study in a Chinese population. J Sex Med 2014;11:521–528.     

Erectile Dysfunction and Premature Ejaculation: Interrelationships and Psychosexual Factors

IntroductionBoth erectile dysfunction (ED) and premature ejaculation (PE) impair the quality of sexual intercourse for both men and their female partners.AimsThis study aims to examine with a large representative sample the interrelationships of measures of ED, PE, typical intravaginal ejaculatory latency time (IELT), men's perceived relationship quality with their mother, and age of first being in love.MethodsIn this cross‐sectional study, a nationally representative sample of 960 Czech coitally experienced men (aged 15–84), provided age, International Index of Erectile Function 5‐item (IIEF‐5), Index of Premature Ejaculation (IPE) scores, IELT, rating of relationship with their mother, and age at first being in love.Main Outcome MeasuresCorrelations, partial correlations adjusting for age, analysis of covariance (ANCOVA), and multiple regression statistical methods were used.ResultsIIEF‐5, IPE, and IELT were significantly intercorrelated (IIEF‐5 and IPE: r = 0.64). Better IIEF‐5 scores were associated with younger age at first (and ever) being in love. Poorer IPE score, shorter IELT, and mild–moderate ED were associated with poorer perceived mother relationship (which was also associated with first being in love at an older age). Multiple regression analyses revealed that: (i) greater IELT was associated with better erectile function and better mother relationship, but not with age; and (ii) IELT of <1 minute was associated with poorer perceived mother relationship and poorer IIEF‐5, but marginally with age. History of homosexual activity was unrelated to IIEF‐5, IPE, IELT, and perceived mother relationship scores.ConclusionsThe findings suggest that degrees of ED and PE are often comorbid, and both ED and PE are associated with less favorable early experiences with women. Brody S and Weiss P. Erectile dysfunction and premature ejaculation: Interrelationships and psychosexual factors. J Sex Med 2015;12:398–404.     

The comparison of premature ejaculation assessment questionnaires and their sensitivity for the four premature ejaculation syndromes: results from the Turkish society of andrology sexual health survey

IntroductionIn addition to the previously defined “lifelong” and “acquired” premature ejaculation (PE), the existence of two more subtypes of PE, namely “natural variable PE” and “premature‐like ejaculatory dysfunction,” has been proposed.AimsTo evaluate the diagnostic value of the Premature Ejaculation Diagnostic Tool (PEDT) and Arabic Index of Premature Ejaculation (AIPE) in a population‐based study, in relation to their sensitivity across these four different PE syndromes and to assess the Premature Ejaculation Profile (PEP) scores of patients with lifelong, acquired, natural variable PE and premature‐like ejaculatory dysfunction.MethodsBetween June 2009 and December 2009, couples were randomly selected from 17 provinces of Turkey. Subjects with the complaint of ejaculating prematurely were classified as lifelong, acquired, natural variable PE, and premature‐like ejaculatory dysfunction according to the medical and sexual history they described. PE status was also assessed with PEDT, AIPE and PEP. The sensitivity, specificity, positive predictive value and negative predictive value were calculated for PEDT and AIPE in the study population whereas detection rates of these two questionnaires were also compared among the four PE syndromes. Moreover, PEP scores of patients with lifelong, acquired, natural variable PE and premature‐like ejaculatory dysfunction were compared. Significance level was considered as P < 0.05.Main Outcome MeasuresScores obtained from PEDT, AIPE, and PEP questionnaires.ResultsA total of 2,593 couples were enrolled where 512 (20.0%) male subjects reported PE. PEDT, AIPE, and PEP measures of the PE patients indicated worse sexual function (P < 0.001 each). Mean scores obtained from questionnaires were significantly better in patients with premature‐like ejaculatory dysfunction and they were the worst in patients with acquired PE (P < 0.001 each). The sensitivity values of PEDT and AIPE were 89.3 and 89.5, whereas their specificity values were 50.5 and 39.1, respectively. There were statistically significant differences in detection rates of PEDT and AIPE among the four PE syndromes (P = 0.006 and P < 0.001). They were higher in acquired and lifelong PE and lower in premature‐like ejaculatory dysfunction.ConclusionsPEDT and AIPE can diagnose PE with high sensitivity, especially in patients with lifelong and acquired PE. The complaint of patients with acquired PE seems to be more severe than those complaining of lifelong, natural variable PE and premature‐like ejaculatory dysfunction patients. Serefoglu EC, Yaman O, Cayan S, Asci R, Orhan I, Usta MF, Ekmekcioglu O, Kendirci M, Semerci B, and Kadioglu A. The comparison of premature ejaculation assessment questionnaires and their sensitivity for the four premature ejaculation syndromes: Results from the Turkish Society of Andrology Sexual Health Survey.     

Effects of Tadalafil on Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia and on Erectile Dysfunction in Sexually Active Men with Both Conditions: Analyses of Pooled Data from Four Randomized,Placebo‐Controlled Tadalafil Clinical Studies

IntroductionErectile dysfunction (ED) and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) are common in aging males and frequently occur together. Tadalafil has demonstrated efficacy in treating both conditions.AimThe study aims to evaluate the efficacy and safety of tadalafil 5 mg once daily vs. placebo over 12 weeks in treating both LUTS/BPH and ED in sexually active men. We also assessed relationships of baseline disease severity and prostate specific antigen (PSA) to outcomes.MethodsData were pooled from four multinational, randomized studies of men ≥45 years with LUTS/BPH, with analyses restricted to sexually active men with ED. Randomization (baseline) followed a 4‐week placebo run‐in; changes from baseline were assessed vs. placebo using analysis of covariance.Main Outcome MeasuresInternational Prostate Symptom Score (IPSS), IPSS subscores, Quality‐of‐Life Index (IPSS‐QoL), BPH Impact Index (BII), and International Index of Erectile Function‐Erectile Function (IIEF‐EF) Domain score were used in this study.ResultsTadalafil (N = 505) significantly improved total IPSS vs. placebo (N = 521); mean changes from baseline were ?6.0 and ?3.6, respectively (P < 0.001). Improvements in IIEF‐EF Domain score (tadalafil, 6.4; placebo, 1.4) were also significant vs. placebo, as were the IPSS storage and voiding subscores, IPSS‐QoL, and BII (all P < 0.001).No significant impact of baseline ED severity or PSA category on IPSS response was observed (interaction P values, 0.463 and 0.149, respectively). Similarly, improvement in IIEF‐EF Domain score was not significantly impacted by baseline LUTS/BPH severity or PSA category (interaction P values, 0.926 and 0.230, respectively). Improvements in IPSS and IIEF‐EF Domain score during treatment were weakly correlated (r = ?0.229). Treatment‐emergent adverse events were consistent with previous reports.ConclusionsTadalafil was efficacious and well tolerated in treating ED and LUTS/BPH in sexually active men with both conditions. Improvements in both conditions were significant regardless of baseline severity. Improvements in the total IPSS and the IIEF‐EF Domain score were weakly correlated. Porst H, Roehrborn CG, Secrest RJ, Esler A, and Viktrup L. Effects of tadalafil on lower urinary tract symptoms secondary to benign prostatic hyperplasia and on erectile dysfunction in sexually active men with both conditions: Analyses of pooled data from four randomized, placebo‐controlled tadalafil clinical studies. J Sex Med 2013;10:2044–2052.