Prevalence of Endocrine and Metabolic Disorders in Subjects with Erectile Dysfunction: A Comparative Study

IntroductionAlterations of gonadal, thyroid, and pituitary hormones, along with metabolic disorders, might be involved in causing erectile dysfunction (ED).AimThe prevalence of endocrine abnormalities in two different cohorts from the general and the symptomatic populations of Florence was compared.MethodsThe first group is a general population sample derived from a Florentine spin-off of the European Male Aging Study (EMAS cohort; n = 202); the second group is a series of n = 3,847 patients attending our clinic for ED (UNIFI cohort).ResultsBoth primary and secondary hypogonadism were more often observed in the UNIFI than in the EMAS cohort (2.8 vs. 0%; P < 0.05 and 18.9 vs. 8%; P < 0.001, respectively). However, only the second association retained statistical significance after adjusting for age. Compensated hypogonadism was more common in the EMAS cohort (4.4 vs. 8.1%; P < 0.05). No statistically significant difference in the prevalence of overt thyroid disorders was observed. Conversely, subclinical hyperthyroidism was more prevalent in the EMAS cohort (2 vs. 4.1%, P < 0.05). No significant difference in the prevalence of hyperprolactinemia was detected, while the prevalence of hypoprolactinemia was significantly higher in the UNIFI than in the EMAS cohort (28.2% vs. 17.8%, P = 0.001), even after the adjustment for age, BMI, and testosterone (P = 0.001). Central obesity (waist ≥102 cm), impaired fasting glucose (IFG), and type 2 diabetes mellitus (T2DM) were more often detected in UNIFI patients (31.7 vs. 22.8%, P < 0.05; 44.5 vs. 33.3%, P < 0.05; 20.1% vs. 1.0%, P < 0.001 in the UNIFI and EMAS cohort, respectively), even after adjusting for age. In contrast, the prevalence of overweight and obesity did not differ between the two groups.ConclusionT2DM, IFG, central obesity, secondary hypogonadism, and hypoprolactinemia are more frequent in subjects consulting for ED than in the general population of the same geographic area. Our data suggest that these conditions could play a central role in determining consultation for ED. Maseroli E, Corona G, Rastrelli G, Lotti F, Cipriani S, Forti G, Mannucci E, and Maggi M. Prevalence of endocrine and metabolic disorders in subjects with erectile dysfunction: A comparative study. J Sex Med 2015;12:956–965.     

Severe Depressive Symptoms and Cardiovascular Risk in Subjects with Erectile Dysfunction

IntroductionErectile dysfunction (ED) and mood depression are often associated and both are correlated with an increased risk of cardiovascular morbidity and mortality.AimThe aim of the present study is to explore biological and clinical correlates of depressive symptomatology in a sample of men consulting for sexual dysfunction and to verify possible associations between depressive symptoms and incidence of major cardiovascular events (MACE).MethodsA consecutive series of 2,303 male patients attending the Outpatient Clinic for sexual dysfunction was retrospectively studied. A subset of the previous sample (N = 1,687) was enrolled in a longitudinal study. All patients were investigated using a Structured Interview on Erectile Dysfunction (SIEDY), composed of 3 scales which explore organic, relational and intra-psychic components of ED. MHQ-D scoring from Middlesex Hospital Questionnaire (MHQ) was used as a putative marker of depressive symptoms.Main Outcome MeasuresInformation on MACE was obtained through the City of Florence Registry Office.ResultsWe found a positive relationship between MHQ-D score and a progressive impairment in obtaining an erection hard enough for penetration, even after adjusting for confounding factors. Moreover, we observed positive relationships between MHQ-D score and the three pathogenetic domains underlying ED. When the longitudinal subset was evaluated, during a mean follow-up of 4.3 ± 2.6 years, 139 MACE, 15 of which were fatal, were observed. Unadjusted incidence of MACE was significantly associated with baseline depressive symptoms. When the presence of severe depressive symptoms were introduced in a Cox regression model, along with the arteriogenic ED and partner's hypoactive sexual desire, after adjusting for age, Chronic Diseases Score, and ΣMHQ (a broader index of psychopathology), severe depressive symptomatology was independently associated with a higher incidence of MACE.ConclusionDepressive symptomatology constitutes an independent risk factor for cardiac morbidity and mortality in men with ED. Bandini E, Fisher AD, Corona G, Ricca V, Monami M, Boddi V, Balzi D, Melani C, Forti G, Mannucci E, and Maggi M. Severe depressive symptoms and cardiovascular risk in subjects with erectile dysfunction.     

Comparing Penile Measurements in Normal and Erectile Dysfunction Subjects

IntroductionWith the increase in penile augmentation procedures it becomes important to assess what is the normal erect penile size in both potent men and men with erectile dysfunction (ED).AimThe aim of this work is to define the average stretched penile size in normal men and ED patients.Main Outcome MeasuresPenile length and girth.MethodsThis study included 1,027 adult men presenting to a university hospital outpatient clinic. Two groups of patients were included in this research work. Group I comprises normal adult men (949) and Group II, ED patients (78). There were no differences of race, age, height, and weight. Penile length and girth were measured using a tape measure and rigid ruler in the fully stretched states in both groups. All penile measurements were performed by the same physician.ResultsIn normal men (Group I) the mean of the fully stretched length was 12.9 ± 1.9 cm and the mean of the fully stretched girth was 8.9 ± 0.9 cm. In ED patients (Group II), the mean of the fully stretched length was 11.2 ± 1.5 cm and the mean of fully stretched girth was 8.8 ± 0.8 cm. Comparing the mean of fully stretched penile lengths in both groups revealed statistical significant difference (P < 0.001) between them, whereas comparing the mean of fully stretched penile girths in both groups revealed statistical nonsignificant difference (P = 0.474) between them. There were significant positive correlations between fully stretched penile lengths and fully stretched penile girths in both groups.ConclusionThe average of fully stretched penile length in normal potent men is 12.9 cm, whereas the patients with ED tend to have significantly shorter penises (11.2 ± 1.5 cm). Kamel I, Gadalla A, Ghanem H, and Oraby M. Comparing penile measurements in normal and erectile dysfunction subjects. J Sex Med 2009;6:2305–2310.     

Standardization of Vascular Assessment of Erectile Dysfunction

IntroductionIn-office evaluation of erectile dysfunction by color duplex Doppler ultrasound (CDDU) may benefit the decision-making process in regard to choosing the most appropriate therapy. Unfortunately, there is no uniform standardization in performing CDDU resulting in high variability in data expression and interpretation when comparing results among various centers, especially when conducting multicenter trials. Establishing standard operating procedures (SOPs) is a major step that will help minimize such variability.AimThis SOP describes CDDU procedure with focus on establishing uniformity and normative parameters.Main Outcome MeasureMeasure intra-arterial diameter, peak systolic velocity, end-diastolic velocity, and resistive index for each cavernosal artery.MethodsAfter initial discussion with the patient about his history and International Index of Erectile Function evaluation describe procedural steps to the patient. Perform the CDDU in a relaxed state, scanning the entire penis (in B-mode image) using a 7.5- to 12-MHz linear array ultrasound probe. An intracorporal injection of a single or combination of vasoactive agents (e.g., prostaglandin E1, phentolamine, and papaverine) is then administered and CDDU performed at various time points, preferably with audiovisual sexual stimulation (AVSS).ResultsMonitor penile erection response (tumescence and rigidity) near peak blood flow. Self-stimulation or AVSS leaving the patient alone in room or redosing may be considered to decrease any anxiety and help achieve a maximum rigid erection.ConclusionConsidering the complexity and heterogeneity of CDDU evaluation, this communication will help in standardization and establish uniformity in such data interpretation. When indicated, invasive diagnostic testing involving (i) penile angiography and (ii) cavernosography/cavernosometry to establish veno-occlusive dysfunction may be recommended to facilitate further treatment options. Sikka SC, Hellstrom WJG, Brock G, and Morales AM. Standardization of vascular assessment of erectile dysfunction. J Sex Med **;**:**–**.     

The Relationship Between Gait Function and Erectile Dysfunction: Results from a Community-Based Cross-Sectional Study in Japan

IntroductionAlthough physical activity is associated with a decreased risk of erectile dysfunction (ED), the association of ED with physical function remains unclear.AimTo investigate the relationship between gait function and ED in a community-dwelling population.MethodsThis cross-sectional study analyzed 324 men who participated in the Iwaki Health Promotion Project in 2015 in Hirosaki, Japan. ED was assessed with the 5-Item International Index of Erectile Function (IIEF-5). The participants were divided into 2 groups: low IIEF-5 score (≤16) and high IIEF-5 score (>16). We evaluated physical function, including gait function and grip strength. Gait function was evaluated by 10-meter gait speed and 2-step score (the ratio of the maximum length of 2 strides to height). We assessed daily physical activity, comorbidities, mental status, and laboratory data. The association between physical function and a low IIEF-5 score was analyzed by multivariate logistic regression analysis.Main Outcome MeasureThe main outcome measure was to assess whether gait function was an independent indicator for erectile dysfunction.ResultsOf 324 men, 154 (48%) had a low IIEF-5 score. Grip strength, 2-step score, and 10-meter gait speed in the low IIEF-5 group were significantly inferior to those in the high IIEF-5 group. Multivariate analysis showed that the 2-step score (odds ratio = 0.08), age, and total testosterone were independently associated with a low IIEF-5.Clinical ImplicationsThis study may motivate clinicians to investigate predictive values of physical function for ED.Strengths & LimitationsThe strength of this study was the use of simple, objective, and feasible tests for gait function to assess its association with ED. The limitations of this study were selection bias, regional bias, and nature of the cross-sectional study.ConclusionsOf the gait functional tests, not the 10-meter gait speed but 2-step score was an independent indicator for the presence of ED.Okamoto T, Hatakeyama S, Imai A, et al. The Relationship Between Gait Function and Erectile Dysfunction: Results from a Community-Based Cross-Sectional Study in Japan. J Sex Med 2019; 16:1922–1929.     

Cavernous Artery Intima-Media Thickness: A New Parameter in the Diagnosis of Vascular Erectile Dysfunction

IntroductionA precise characterization of erectile dysfunction (ED) of vascular origin has not yet been achieved. Although cavernous peak systolic velocity (PSV) is generally considered a major parameter, it has many false positives and negatives because of anatomic variations of the cavernous artery course, challenging site of sampling, insufficient caracterization of an early phase of vascular disease, and significant influence of adrenergic tone.AimWe performed a high magnification ultrasonographic study in order to compare functional and morphological parameters of the cavernous artery to PSV and their relation with penile and systemic atherosclerosis.MethodsA total of 109 subjects (84 ED patients and 25 controls) evaluated in our andrological center from March 2007 to January 2008 were enrolled in the study.Main Outcome MeasuresAll subjects underwent medical history, erectile function domain of the International Index of Erectile Function, physical examination, routine and sex hormone blood tests, and high resolution echo color doppler evaluation of carotid, femoral and penile districts (acceleration time, intima media thickness [IMT], intima adventitia thickness, caliper before and after intracavernous alprostadil injection [Δ-cavernous calliper]).ResultsCavernous parameters were significantly different between ED and controls. Multivariate model showed that IMT was the only predicting parameter for ED of vascular origin. Cavernous IMT showed a strong direct correlation with carotid and femoral IMT. ED patients with two or more cardiovascular risk factors had a significantly higher cavernous IMT.ConclusionsAn increased cavernous IMT (≥0.3 mm) might predict ED of vascular origin with more accuracy than PSV and could be a sensitive predictor also for systemic atherosclerosis at an earlier phase. Caretta N, Palego P, Schipilliti M, Ferlin A, Di Mambro A, and Foresta C. Cavernous artery intima-media thickness: A new parameter in the diagnosis of vascular erectile dysfunction. J Sex Med **;**:**–**.     

Standard Operating Procedures for Vascular Surgery in Erectile Dysfunction: Revascularization and Venous Procedures

IntroductionThe impact of penile blood supply on erectile function was recognized some 500 years ago. At the turn of the 20th century first results of penile venous ligation were published and in 1973 the first surgical attempts to restore penile arterial inflow were undertaken. Numerous techniques were published in the meantime, but inclusion criteria, patient selection, and success evaluation differed extremely between study groups.AimTo develop evidence-based standard operating procedures (SOPs) for vascular surgery in erectile dysfunction, based on recent state of the art consensus reports and recently published articles in peer-reviewed journals.MethodsBased on the recent publication of the consensus process during the 2009 International Consultation on Sexual Medicine in Paris, recommendations are derived for diagnosis and surgical treatment of vascular erectile dysfunction. In addition several recent publications in this field not mentioned in the consensus statements are included in the discussion.Main Outcome MeasureThe Oxford system of evidence-based review was systematically applied. Due to the generally low level of evidence in this field expert opinions were accepted, if published after a well-defined consensus process in peer-reviewed journals.ResultsReferring to penile revascularization it may be concluded, that in the face of missing randomized trials, only recommendations grade D may be given: this kind of surgery may be offered to men less than 55 years, who are nonsmokers, nondiabetic, and demonstrate isolated arterial stenoses in the absence of generalized vascular disease.The evidence level for recommendations concerning penile venous ligations may be even lower. Too many unsolved controversies exist and universal diagnostic criteria for patient selection as well as operative technique selection have not been unequivocally established. This kind of surgery is still considered investigational but may be offered in special situations on an individualized basis in an investigational or research setting after obtaining written consent, using both pre- and postoperatively validated measuring instruments of success evaluation.ConclusionsSOPs for penile revascularization procedures can be developed, concerning a highly selected patient group with isolated arterial stenoses. Based on the available data it is not yet possible to define SOPs for surgical treatment of corporal veno-occlusive dysfunction. Sohn M, Hatzinger M, Goldstein I, and Krishnamurti S. Standard operating procedures for vascular surgery in erectile dysfunction: Revascularization and venous procedures. J Sex Med 2013;10:172-179.     

Bicycle Riding and Erectile Dysfunction: A Review

IntroductionFor many years, reports in the literature have implicated bicycle riding as causing increased risk of erectile dysfunction (ED). Perineal compression during cycling has been associated with the development of sexual complications.AimTo review current literature on the rationale for ED from bicycle riding and outcome of bicycle riding on erectile function and to present available research on preventative measures specifically regarding bicycle riding.MethodsA systematic comprehensive literature review.ResultsThere is a significant relationship between cycling-induced perineal compression leading to vascular, endothelial, and neurogenic dysfunction in men and the development of ED. Research on female bicyclists is very limited but indicates the same impairment as in male bicyclists. Preventative measures including use of a properly fitted bicycle, a riding style with a suitable seat position and an appropriate bicycle seat can help prevent impairment of erectile function.ConclusionsThere is a need for further research on safe bicycle and bicycle seat design and investigations that address the underlying mechanisms leading to cycling-related sexual dysfunction in both male and female bicyclists. Sommer F, Goldstein I, and Korda JB. Bicycle riding and erectile dysfunction: A review.     

Implants,Mechanical Devices,and Vascular Surgery for Erectile Dysfunction

IntroductionThe field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment.AimTo develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery.MethodsTo provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period.Main Outcome MeasureExpert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.ResultsThe inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended.ConclusionsIt is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient's medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery. Hellstrom WJG, Montague DK, Moncada I, Carson C, Minhas S, Faria G, and Krishnamurti S. Implants, mechanical devices, and vascular surgery for erectile dysfunction.     

Coronary Phenotypes in Patients with Erectile Dysfunction and Silent Ischemic Heart Disease: A Pilot Study

IntroductionAccumulated evidence shows that erectile dysfunction (ED) may be a precursor of coronary artery disease (CAD).AimsThe purpose of this study was to explore the differences in coronary phenotypes between patients with ED and patients with angina pectoris.MethodsThe study enrolled 30 ED patients (study group) and 120 age-matched angina patients who had no ED (control group). All patients had angiographically documented CAD.Main Outcome MeasuresThe differences in demographic characteristics, biochemical profiles and coronary characteristics between the study and control groups were compared.ResultsDiabetes mellitus (DM) and obesity defined by body mass index were more common in the study group than in the control group. The mean number of lesions and mean number of vessels with evidence of CAD were significantly different between the study and control groups (2.3 ± 0.1 vs. 2.2 ± 0.1, P < 0.001; 2.0 ± 0.2 vs. 1.8 ± 0.1, P < 0.001). The distribution of vessel involvement was similar between the groups, except for more common involvement of the ramus in the study group. There were no differences in distribution of lesion sites between the two groups. The control group had a higher percentage of type A stenotic lesions than the study group (16.3% vs. 2.9%, P = 0.004). Significant differences were also observed in type C lesions (52.9% in study group vs. 38.0% in control group, P = 0.026). Fewer calcified, irregular, and bifurcated lesions were present in the study group compared to control.ConclusionsThis study documented coronary phenotypes in ED patients without symptomatic CAD. Although the artery size hypothesis and ED had well been thought to be a precursor of CAD, the severity of coronary lesions in these patients was not more benign than that observed in angina pectoris patients who have no ED. Chang S-T, Chu C-M, Hsiao J-F, Chung C-M, Shee J-J, Chen C-S, and Hsu J-T. Coronary phenotypes in patients with erectile dysfunction and silent ischemic heart disease: A pilot study.     

Male Sexuality and Cardiovascular Risk. A Cohort Study in Patients with Erectile Dysfunction

IntroductionAlthough penile blood flow (PBF) has been recommended as an additional diagnostic test in identifying erectile dysfunction (ED) patients at risk for latent cardiovascular disease, no study has ever assessed the possible association of PBF and the relational component of sexual function with incident major cardiovascular events (MACE).AimThe aim of this study is to investigate whether severity of ED, PBF, and other factors related to a couple's relationship predict incident MACE.MethodsA consecutive series of 1,687 patients was studied. Different clinical, biochemical, and instrumental (penile flow at color Doppler ultrasound) parameters were evaluated.Main Outcome MeasuresInformation on MACE was obtained through the City of Florence Registry Office.ResultsDuring a mean follow-up of 4.3 ± 2.6 years, 139 MACE, 15 of which were fatal, were observed. Cox regression analysis, after adjustment for age and Chronic Disease Score, showed that severe ED predicted MACE (hazard ratio [HR] 1.75; 95% confidence interval 1.10–2.78; P < 0.05). In addition, lower PBF, evaluated both in flaccid (before) and dynamic (after prostaglandin-E1 stimulation) conditions, was associated with an increased risk of MACE (HR = 2.67 [1.42–5.04] and 1.57 [1.01–2.47], respectively, for flaccid [<13 cm/second] and dynamic [<25 cm/second] peak systolic velocity; both P < 0.05). Reported high sexual interest in the partner and low sexual interest in the patient proved to have a protective effect against MACE.ConclusionsThe investigation of male sexuality, and in particular PBF, and sexual desire, could provide insights not only into present cardiovascular status but also into prospective risk. Corona G, Monami M, Boddi V, Cameron-Smith M, Lotti F, de Vita G, Melani C, Balzi D, Sforza A, Forti G, Mannucci E, and Maggi M. Male sexuality and cardiovascular risk. A cohort study in patients with erectile dysfunction.     

Behavior-Related Erectile Dysfunction: A Systematic Review and Meta-Analysis

BackgroundErectile dysfunction (ED) is a common problem among men across the world. It is usually multifactorial in origin. Behavioral factors can be related to the development of ED and related to many other chronic diseases. It impacts not only the sexual function but also the psychology and their overall quality of life.AimTo determine the association of the behavior factors in relation to ED and to identify the risk and protective factors.MethodA systematic review search based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted. The primary databases PubMed, PlosOne, Oxford Academic, SCOPUS, and Ovid were accessed using specific keyword searches. Quality of articles was assessed by using Newcastle-Ottawa Assessment Scale according to the study design.OutcomeEvaluation of the relationship between behavioral factors and ED.Results24 studies were identified from the 5 databases which met the predetermined criteria. Overall, the study population include adult male age between 18 and 80 years. The sample size of the studies ranges from 101 to the largest sample size of 51,329. Smoking, alcohol, and drugs usage are found to be risk factors for ED. Meanwhile, dietary intake, physical activity, and intimacy are the protective factors for ED.Clinical ImplicationThe findings from this review may aid clinicians to aim for early detection of ED by screening their risk factors and providing early treatment. This can also be used to promote awareness to the community on the sexual health and factors that can affect their sexual function.Strength & LimitationThis study looks at all types of behavioral factors that may affect ED; however, there was a substantial heterogeneity detected across the selected study factors. Furthermore, the lack of PROSPERO registration is also a limitation in this study.ConclusionOverall, smoking, dietary intake, alcohol consumption, drugs, and physical activities are modifiable risk factors for ED in men. Therefore, it is crucial to promote healthy lifestyle and empower men to prevent ED and early detection of ED for early treatment.Sivaratnam L, Selimin DS, Abd Ghani SR, et al. Behavior-Related Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2021;18:121–143.     

Association Between Psoriasis and Erectile Dysfunction: A Meta-Analysis

Background

Several studies have shown a relationship between psoriasis and erectile dysfunction (ED), but a meta-analysis of the data has not been performed.

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.     

Hormonal Association and Sexual Dysfunction in Patients with Impaired Fasting Glucose: A Cross-Sectional and Longitudinal Study

IntroductionThe category of impaired fasting glucose (IFG) denotes a state of nondiabetic hyperglycemia, considered a risk factor for the further development of diabetes mellitus (DM) and cardiovascular (CV) diseases.AimThe aim of the present study is to evaluate the impact of IFG on sexual health in men. In addition, its effect on CV morbidity and mortality will also be addressed.MethodsA consecutive series of 3,451 men (mean age 57.3 ± 10.1 years) attending our outpatient clinic for sexual dysfunction was retrospectively studied. A subset of this sample (N = 1,687) was enrolled in a longitudinal study.Main Outcome MeasuresSeveral clinical, biochemical (including testosterone), and instrumental (penile color Doppler ultrasound) factors were evaluated. IFG was defined by fasting glucose concentrations between 5.6 and 6.9 mmol/L (100–125 mg/dL). A higher threshold (6.1–6.9 mmol/L, 110–125 mg/dL) was also considered.ResultsAmong the patients studied, 747 (21.7%) had DM. In addition, 659 (19.1%) subjects were classified as IFG. Patients with IFG, however defined, more often had severe ED, reduced penile blood flow, and overt hypogonadism when compared with patients with normal glucose levels. In addition, men with ED and IFG show poorer blood pressure and lipid profile with an overall increase in CV risk. Unadjusted incidence of major adverse CV events was significantly associated with baseline DM, whereas there was a trend toward higher risk also for IFG, but this did not reach statistical significance. Conversely, both IFG and DM were significantly associated with a higher risk of fatal and nonfatal cerebral events.ConclusionsChecking glucose and testosterone levels is mandatory in subjects with ED because testosterone substitution in impotent IFG subjects might ameliorate not only their sexual life but also their overall health. Corona G, Rastrelli G, Balercia G, Lotti F, Sforza A, Monami M, Forti G, Mannucci E, and Maggi M. Hormonal association and sexual dysfunction in patients with impaired fasting glucose: A cross-sectional and longitudinal study. J Sex Med 2012;9:1669–1680.     

Impact of Nonorganic Erectile Dysfunction on Spouses: A Study from India

IntroductionThe overall outcome of men with erectile dysfunction (ED) depends a lot on participation in treatment of their partners/spouses. However, psychosexual functioning of partners/spouses has received scant attention.AimTo study the psychosexual functioning of spouses of men with nonorganic ED in terms of their sexual satisfaction, psychological problems, marital adjustment, quality of life, and level of dysfunction.Main Outcome MeasuresThe main outcome measures for the partners of men with ED were symptom questionnaire, marital questionnaire (KDS-15 marital questionnaire), sexuality scale, quality of life enjoyment and satisfaction questionnaire, dyadic adjustment scale, and dysfunction analysis questionnaire.MethodSpouses of men with ED (n = 50) and spouses of men without any psychosexual dysfunction (n = 50) were compared for sexual and marital function, quality of life, and dyadic adjustment. The psychological impact was assessed by symptom questionnaire.ResultsSpouses of men with ED have significantly lower levels of marital and sexual satisfaction and higher levels of psychiatric symptoms than controls. Furthermore, the spouses of men with nonorganic ED also report poor quality of life in most domains of life and had higher level of dysfunction.ConclusionOur findings support the Western data with regard to the psychosexual functioning of spouses/partners of men with ED and suggest that spouses/partners of men with ED should also be assessed thoroughly. Avasthi A, Grover S, Kaur R, Prakash O, and Kulhara P. Impact of nonorganic erectile dysfunction on spouses: A study from India.     

Erectile Dysfunction and Decreased Libido in Klinefelter Syndrome: A Prevalence Meta-Analysis and Meta-Regression Study

BackgroundOnly few studies have assessed sexual dysfunction in men with Klinefelter syndrome (KS).AimTo define pooled prevalence estimates and correlates of erectile dysfunction (ED) and decreased libido (DL) in KS.MethodsA thorough search of Medline, Embase and Web of Science was performed to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effect models and the between-studies heterogeneity was assessed by the Cochrane's Q and I². The sources of heterogeneity were investigated by meta-regression and sub-group analyses. Funnel plot, Begg's rank correlation and trim-and-fill test were used to assess publication bias.Main Outcome MeasureThe pooled prevalence of ED and DL in KS as well as 95% confidence intervals (CIs) were estimated from the proportion of cases of sexual dysfunction and the sample size. Variables that could affect the estimates were identified by linear meta-regression models.ResultsSixteen studies included collectively gave information about ED and DL in 482 and 368 KS men, respectively, resulting in a pooled prevalence of 28% (95% CI: 19%–36%) for ED and 51% (95% CI: 36%–66%) for DL, with a large heterogeneity. The trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimates. At the meta-regression analyses, a higher prevalence of ED was significantly associated with an older age but not with lower testosterone levels. In series with a mean age >35 years, the ED prevalence estimate increased up to 38% (95% CI: 31%–44%) with no heterogeneity (I²=0.0%, P=0.6). On the contrary, the prevalence of DL increased significantly as testosterone levels decreased, without a significant relationship with age.Clinical ImplicationsWhile DL would largely reflect an androgen deficiency, in older men with KS, erectile function should be assessed irrespective of testosterone levels.Strength & LimitationsThis is the first meta-analysis defining pooled prevalence estimates and correlates of ED and DL in KS. Nevertheless, caution is required when interpreting results, due to the high risk of bias in many studies, as well as the dearth of data about psychosocial and/or psychosexological variables and age at the diagnosis.ConclusionsED and DL represent common clinical complaints in KS. While the prevalence of ED would increase with age, DL gets more common as serum testosterone decreases. Further studies are warranted to elucidate the pathogenetic mechanism(s) underlying the age-dependent increase in the prevalence of ED, apparently unrelated to the androgenic status.A Barbonetti, S D'Andrea, W Vena, et al. Erectile Dysfunction and Decreased Libido in Klinefelter Syndrome: A Prevalence Meta-Analysis and Meta-Regression Study. J Sex Med 2021;18:1054–1064.     

Erectile Dysfunction and Mortality

IntroductionErectile dysfunction (ED) and cardiovascular disease (CVD) share pathophysiological mechanisms and often co-occur. Yet it is not known whether ED provides an early warning for increased CVD or other causes of mortality.AimWe sought to examine the association of ED with all-cause and cause-specific mortality.MethodsProspective population-based study of 1,709 men (of 3,258 eligible) aged 40–70 years. ED was measured by self-report. Subjects were followed for a mean of 15 years. Hazard ratios (HR) were calculated using the Cox proportional hazards regression model.Main Outcome MeasuresMortality due to all causes, CVD, malignant neoplasms, and other causes.ResultsOf 1,709 men, 1,284 survived to the end of 2004 and had complete ED and age data. Of 403 men who died, 371 had complete data. After adjustment for age, body mass index, alcohol consumption, physical activity, cigarette smoking, self-assessed health, and self-reported heart disease, hypertension, and diabetes, ED was associated with HRs of 1.26 (95% confidence interval [CI] 1.01–1.57) for all-cause mortality, and 1.43 (95% CI 1.00–2.05) for CVD mortality. The HR for CVD mortality associated with ED is of comparable magnitude to HRs of some conventional CVD risk factors.ConclusionsThese findings demonstrate that ED is significantly associated with increased all-cause mortality, primarily through its association with CVD mortality. Araujo AB, Travison TG, Ganz P, Chiu GR, Kupelian V, Rosen R, Hall SA, and McKinlay JB. Erectile dysfunction and mortality. J Sex Med 2009;6:2445–2454.     

Inflatable Penile Prosthesis Placement in Men with Peyronie's Disease and Drug-resistant Erectile Dysfunction: A Single-Center Study

IntroductionErectile dysfunction (ED) frequently accompanies Peyronie's disease (PD) and changes the therapeutic approach.AimTo evaluate a single-center experience with inflatable penile prostheses (IPP) in men with medication refractory ED and PD.MethodsNinety men underwent placement of an IPP with straightening maneuvers as necessary to address their deformity and ED.Main Outcome MeasuresPreoperative assessment included International Index of Erectile Function-erectile function domain (IIEF-EF) and duplex ultrasound to confirm ED and measure erect deformity. Postoperative assessment included a modified Erectile Dysfunction Index of Treatment Satisfaction (EDITS) questionnaire, as well as office visits at 1, 6, and every 12 months thereafter.ResultsComplete chart review was performed with mean follow-up of 49 months. Mean preoperative IIEF-EF score was 11. Full rigidity was not obtained in any patient during duplex ultrasound. Mean curvature at maximum erection was 53°. There were seven mechanical failures requiring device replacement, two revision surgeries for pump or reservoir malposition, one infected device, and two corporoplasties for distal tunica erosion. Postoperative office assessment revealed a functionally straight (i.e., <20°) erect penis and a properly positioned as well as operational device in all patients. The modified EDITS questionnaire was returned by 56 (62%). Overall, 84% of patients were satisfied with their outcome, yet only 73% were satisfied with their straightness. Patient perceived postoperative curvature correction stabilized quickly and was complete by 3 months in 84% of patients. Satisfaction with ease of inflation, deflation, and concealability was 84%, 71%, and 91%, respectively. Coital activity was reported by 91% of men in this group.ConclusionIn men with PD and ED, IPP placement allowed reliable and satisfactory coitus for the great majority of men. Mechanical failure was 7%. Men with PD undergoing IPP placement should be counseled regarding potential penile length loss and residual curvature, neither of which appeared to interfere with coitus but may reduce satisfaction. Levine LA, Benson J, and Hoover C. Inflatable penile prosthesis placement in men with Peyronie's disease and drug-resistant erectile dysfunction: A single-center study.