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 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.     

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.     

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 **;**:**–**.     

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.     

Prevalence and risk factors for erectile dysfunction in Korean men: results of an epidemiological study

IntroductionThe prevalence of erectile dysfunction (ED) and associated risk factors has been described in many countries, but there are still only a few studies from Asia.AimWe investigated the prevalences of ED and premature ejaculation (PE) in Korean men and the impact of general health, lifestyle, and psychosocial factors on these conditions.MethodsTo assess ED and PE, 1,570 Korean men aged 40–79 years were interviewed with a self-administered questionnaire on sexual function and the International Index of Erectile Function (IIEF)-5. In addition, blood chemistry was analyzed for each subject.Main Outcome MeasuresThe prevalences of ED and PE were obtained from self-reported ED, IIEF-5 scoring, EF (erectile function) domain scoring, and self-reported intravaginal ejaculatory latency time (IELT). The data were analyzed for the presence of risk factors and the relationship of general health, lifestyle, and psychosocial factors with ED.ResultsThe prevalences of ED among Korean men were 13.4% (self-reported ED) and 32.4% (IIEF-5 score ≤ 17), and PE prevalences were 11% (IELT ≤ 2-min) and 33.1% (IELT ≤ 5-min). ED was more prevalent in the subject groups with older age, lower income, or lower education, and in subjects without a spouse. ED prevalence was positively associated with risk factors such as diabetes, hypertension, heart disease, psychological stress, and obesity. Levels of serum hemoglobin (Hb) A1c, triglycerides, testosterone, or dehydroepiandrosterone sulfate (DHEA-S) were significantly different between the ED and non-ED groups.ConclusionsThe prevalences of ED and PE in Korean men were 13.4% (self-reported ED) and 11% (IELT ≤ 2-min), respectively. Risk factors and other socioeconomic and mental health factors were associated with ED prevalence. Biochemical factors such as HbA1c, triglycerides, testosterone, and DHEA-S were significantly related to ED prevalence. Ahn TY, Park JK, Lee SW, Hong JH, Park NC, Kim JJ, Park K, Park H, and Hyun JS. Prevalence and risk factors for erectile dysfunction in Korean men: Results of an epidemiological study.     

The Relationship between Self‐Estimated Intravaginal Ejaculatory Latency Time and International Prostate Symptom Score in Middle‐Aged Men Complaining of Ejaculating Prematurely in China

IntroductionSome factors associated with the four premature ejaculation (PE) syndromes have been studied, but the association between International Prostate Symptom Score (IPSS) and the four PE syndromes has not been investigated.AimsWe performed this study to evaluate the association between IPSS and intravaginal ejaculatory latency time (IELT) in men with the four PE syndromes.MethodsFrom June 2012 to January 2014, a total of 690 men aged 40–59 years complaining of ejaculating prematurely and another 452 male healthy subjects of the same age without these complaints were included in this study. Men with the complaints of ejaculating prematurely were classified as one of the four PE syndromes: lifelong PE, acquired PE (APE), variable PE, and subjective PE. Each of them completed a detailed questionnaire including information on demographics, medical and sexual history (e.g., self‐estimated IELT), IPSS, and International Index of Erectile Function‐5.Main Outcome MeasuresAssociations between IPSS and self‐estimated IELT in middle‐aged men with the four PE syndromes.ResultsMen complaining of ejaculating prematurely reported higher IPSS (11.2 ± 6.0 vs. 5.5 ± 3.3) and shorter self‐estimated IELT (2.1 ± 1.6 minutes vs. 4.8 ± 3.3) than men without complaints (P < 0.001 for each). By unilabiate analysis, self‐estimated IELT in men with the four PE syndromes showed significant correlations with IPSS (P < 0.001 for all). After adjusting for age, self‐estimated IELT was negatively associated with IPSS in men with PE complaints (adjusted r = −0.378, P < 0.001). Also, the association was stronger in men with APE (adjusted r = −0.502, P < 0.001).ConclusionsMen complaining of ejaculating prematurely reported worse IPSS than men without these complaints. Self‐estimated IELT was negatively associated with IPSS in men complaining of ejaculating prematurely, and the correlation was the strongest in men with APE. Zhang X, Tang D, Xu C, Gao P, Hao Z, Zhou J, and Liang C. The relationship between self‐estimated intravaginal ejaculatory latency time and international prostate symptom score in middle‐aged men complaining of ejaculating prematurely in China. J Sex Med 2015;12:705–712.     

Baseline Characteristics and Treatment Outcomes for Men with Acquired or Lifelong Premature Ejaculation with Mild or No Erectile Dysfunction: Integrated Analyses of Two Phase 3 Dapoxetine Trials

IntroductionPremature ejaculation (PE) is classified as an acquired or lifelong condition but data on baseline characteristics and response to treatment of men with acquired or lifelong PE and mild erectile dysfunction (ED) or normal erectile function (EF) is limited.AimTo present integrated analyses of baseline characteristics and treatment outcomes from phase 3 dapoxetine trials in men with acquired or lifelong PE and mild or no ED.MethodsData were analyzed from two randomized, double-blind, placebo-controlled, phase 3 clinical trials (International and Asia-Pacific) that evaluated efficacy and safety of dapoxetine (30 mg or 60 mg as needed [PRN]) in patients with PE. Men were ≥18 years, in a stable monogamous relationship for ≥6 months, met DSM-IV-TR criteria for PE for ≥6 months, had an International Index of Erectile Function EF domain score ≥21, and had an intravaginal ejaculatory latency time (IELT) ≤2 minutes in ≥75% of intercourse episodes.Main Outcome MeasuresDemographics, sexual history, and PE symptomatology at baseline, and mean IELT and patient-reported outcomes (PROs) at study end (week 12), were analyzed for men with acquired or lifelong PE and mild or no ED (EF score 21–25 vs. ≥26).ResultsBaseline characteristics except duration of PE were similar in men with acquired and lifelong PE, with no other differentiating features by ED status. Dapoxetine treatment improved significantly mean IELT (arithmetic and geometric) and PRO responses (perceived control over ejaculation, satisfaction with sexual intercourse, ejaculation-related personal distress, and interpersonal difficulty) for acquired and lifelong subtypes, but presence of mild ED diminished PRO responsiveness in both subtypes, particularly those with lifelong PE.ConclusionsBaseline characteristics and treatment outcomes were generally similar in men with acquired and lifelong PE. The presence of mild ED appears to be associated with a more modest treatment response, irrespective of lifelong or acquired PE subtype. Porst H, McMahon CG, Althof SE, Sharlip I, Bull S, Aquilina JW, Tesfaye F, and Rivas DA. Baseline characteristics and treatment outcomes for men with acquired or lifelong premature ejaculation with mild or no erectile dysfunction: Integrated analyses of two phase 3 dapoxetine trials.     

Safety and Efficacy of Epelsiban in the Treatment of Men with Premature Ejaculation: A Randomized,Double‐Blind,Placebo‐Controlled,Fixed‐Dose Study

AimTo assess the efficacy and safety of the selective oxytocin receptor antagonist epelsiban in the treatment of premature ejaculation (PE).MethodsDouble‐blind, randomized, parallel‐group, placebo‐controlled, stopwatch‐monitored, phase 2, multicenter study (GSK557296; NCT01021553) conducted in men (N = 77) 18–55 years of age, with PE defined as per International Society for Sexual Medicine consensus definition. Patients provided informed consent prior to a 4‐week un‐medicated run‐in to determine baseline intravaginal ejaculatory latency times (IELT) recorded in an electronic diary. Patients needed to make a minimum of four intercourse attempts and have a mean IELT <65 seconds to be considered for randomization. Men with moderate‐to‐severe erectile dysfunction were excluded from the study. Eligible patients were randomized to placebo, epelsiban 50 mg, or 150 mg, taken 1 hour before sexual activity. Active treatment IELT times were recorded in an electronic diary, along with subjective measures of intercourse satisfaction, over an 8‐week treatment period. The Modified Index of Premature Ejaculation and International Index of Erectile Function were completed at study visits.Main Outcome MeasuresStopwatch timed IELT recordings and a modified version of the patient‐reported outcome questionnaire the IPE were used in this study to determine the effect of epelsiban when taken orally prior to intercourse in subjects diagnosed with PE.ResultsThe baseline (mean) IELT for patients pretreatment was (0.52, 0.63, and 0.59 minutes) for placebo, epelsiban 50 mg and 150 mg, respectively. On‐treatment, average geometric least squares means of the median IELT values (mean) were slightly higher in the 50 mg and 150 mg groups (0.72 and 0.69 minutes), respectively, vs. the placebo group (0.62 minutes). Headache was the most common adverse event, and rates were similar across all groups.ConclusionsEpelsiban 50 mg and 150 mg were well tolerated, but did not result in a clinically or statistically significant change in IELT in men with PE, compared with placebo. Shinghal R, Barnes A, Mahar KM, Stier B, Giancaterino L, Condreay LD, Black L, and McCallum SW. Safety and efficacy of epelsiban in the treatment of men with premature ejaculation: A randomized, double‐blind, placebo‐controlled, fixed‐dose study. J Sex Med 2013;10:2506–2517.     

Ethnic Differences in Sexual Dysfunction among Diabetic and Nondiabetic Males: The Oxford Sexual Dysfunction Study

IntroductionErectile dysfunction (ED), premature ejaculation (PE), and reduced libido are common yet poorly investigated complications of diabetes especially among South Asians (SA).AimTo determine possible variations in prevalence and interassociations of ED, PE, and reduced libido among SA and Europids with and without diabetes.MethodMen with diabetes and a randomly selected sample of age‐matched nondiabetic men from 25 general practitioners in eight primary care trusts in the United Kingdom were invited to participate in a linguistically validated questionnaire‐based study in English, Hindi, Urdu, Panjabi, Tamil, and Sinhala languages.Main Outcome MeasuresED, assessed by International Index of Erectile Function (IIEF‐5), PE, evaluated using the Premature Ejaculation Diagnostic Tool, and libido, assessed by asking participants to grade their desire for sexual activity.ResultsSample size was 510 (SA: 184, Europid: 326). Mean age was 56.9 ± 9.7 years. There was no difference in erectile function when assessed by IIEF between SA and Europids with diabetes (84.8% and 84.1%, respectively). The overall prevalence of PE was 28.8% (32.6% and 25.8% in those with and without diabetes, respectively, P = NS). Among men with diabetes, the prevalence of PE was 45.8% and 22.4% for SA and Europids, respectively (P < 0.001). In those without diabetes, this figure was 41.9% in SA and 20.2% in Europids (P < 0.001). There was a significant trend of increasing prevalence of PE with increasing severity grade of ED (P < 0.001). Reduced libido was reported by 26.9% men (32.8% and 22.0% in those with and without diabetes, respectively, P < 0.01), with no significant ethnic difference. The association between reduced libido and increasing severity grades of ED was also significant (P < 0.001).ConclusionsNo significant difference was observed in the prevalence of ED between SA and Europid men with diabetes. PE was significantly more common in the SA men irrespective of their diabetes status. Malavige LS, Wijesekara P, Seneviratne Epa D, Ranasinghe P, and Levy JC. Ethnic differences in sexual dysfunction among diabetic and nondiabetic males: The Oxford Sexual Dysfunction Study. J Sex Med **;**:**–**.     

Erectile Dysfunction after Sickle Cell Disease–Associated Recurrent Ischemic Priapism: Profile and Risk Factors

IntroductionRisk factors associated with erectile dysfunction (ED) that results from recurrent ischemic priapism (RIP) in sickle cell disease (SCD) are incompletely defined.AimThis study aims to determine and compare ED risk factors associated with SCD and non‐SCD‐related “minor” RIP, defined as having ≥2 episodes of ischemic priapism within the past 6 months, with the majority (>75%) of episodes lasting <5 hours.MethodsWe performed a retrospective study of RIP in SCD and non‐SCD patients presenting from June 2004 to March 2014 using the International Index of Erectile Function (IIEF), IIEF‐5, and priapism‐specific questionnaires.Main Outcome MeasuresPrevalence rates and risk factor correlations for ED associated with RIP.ResultsThe study was comprised of 59 patients (40 SCD [mean age 28.2 ± 8.9 years] and 19 non‐SCD [15 idiopathic and four drug‐related etiologies] [mean age 32.6 ± 11.7 years]). Nineteen of 40 (47.5%) SCD patients vs. four of 19 (21.1%) non‐SCD patients (39% overall) had ED (IIEF <26 or IIEF‐5 <22) (P = 0.052). SCD patients had a longer mean time‐length with RIP than non‐SCD patients (P = 0.004). Thirty of 40 (75%) SCD patients vs. 10 of 19 (52.6%) non‐SCD patients (P = 0.14) had “very minor” RIP (episodes regularly lasting ≤2 hours). Twenty‐eight of 40 (70%) SCD patients vs. 14 of 19 (73.7%) non‐SCD patients had weekly or more frequent episodes (P = 1). Of all patients with very minor RIP, ED was found among 14 of 30 (46.7%) SCD patients vs. none of 10 (0%) non‐SCD patients (P = 0.008). Using logistic regression analysis, the odds ratio for developing ED was 4.7 for SCD patients, when controlling for RIP variables (95% confidence interval: 1.1–21.0).ConclusionsED is associated with RIP, occurring in nearly 40% of affected individuals overall. SCD patients are more likely to experience ED in the setting of “very minor” RIP episodes and are five times more likely to develop ED compared with non‐SCD patients. Anele UA and Burnett AL. Erectile dysfunction after sickle cell disease–associated recurrent ischemic priapism: Profile and risk factors. J Sex Med 2015;12:713–719.     

Choosing the best candidates for penile rehabilitation after bilateral nerve-sparing radical prostatectomy

IntroductionControversy exists regarding the ideal candidates for penile rehabilitation after bilateral nerve‐sparing radical prostatectomy (BNSRP).AimTo test the effect of penile rehabilitation according to preoperative patient characteristics.MethodsWe included 435 consecutive patients treated with BNSRP between 2004 and 2008. Preoperative age, International Index of Erectile Function (IIEF) and Charlson Comorbidity Index (CCI) were used to subdivide patients into three groups according to foreseen risk of erectile dysfunction (ED) after surgery: low (age ≤65, IIEF‐erectile function (EF) ≥26, CCI ≤1; N = 184), intermediate (age 66–69 or IIEF‐EF 11–25, CCI ≤1; N = 115), and high (age ≥70 or IIEF‐EF ≤10 or CCI ≥2; N = 136). The Kaplan–Meier method was used to test the difference in EF recovery rates among patients left untreated after surgery (N = 193), those receiving on‐demand phosphodiesterase type 5 inhibitors (PDE5‐I; N = 147), and those treated with chronic use of PDE5‐I (taken every day or every other day for 3–6 months; N = 95). The same analyses were repeated within each risk category.Main Outcome MeasureErectile function (EF) was evaluated using the International Index of Erectile Function (IIEF). Recovery of EF after BNSRP was defined as an IIEF‐EF domain score ≥22.ResultsNo difference in terms of EF recovery was found between patients receiving on‐demand vs. daily PDE5‐I (P = 0.09) in the overall population. Similarly, comparable efficacy of the two treatment schedules (on‐demand vs. chronic) was demonstrated in patients with low and high risk of ED (all P ≥ 0.8). Conversely, daily therapy with PDE5‐I showed significantly higher efficacy for the EF recovery rate compared with the on‐demand PDE5‐I administration schedule in patients with intermediate risk of ED (3‐year EF recovery: 74% vs. 52%, respectively; P = 0.02).Conclusions.The ideal candidates for penile rehabilitation after surgery are patients at intermediate risk of ED. Briganti A, Di Trapani E, Abdollah F, Gallina A, Suardi N, Capitanio U, Tutolo M, Passoni N, Salonia A, DiGirolamo V, Colombo R, Guazzoni G, Rigatti P, and Montorsi F. Choosing the best candidates for penile rehabilitation after bilateral nerve‐sparing radical prostatectomy. J Sex Med 2012;9:608–617.     

Relationship between premature ejaculation and depression in Korean males

IntroductionThe psychological impacts of premature ejaculation (PE), which include guilt, anxiety, and distress, have been well established in Western countries. However, in Asia, although a substantial number of epidemiological studies have surveyed the prevalence of PE, researchers have not thoroughly investigated the relationship between PE and depression, or have defined PE properly.AimWe studied the association between PE and depression and other psychological disturbances, in a Korean cohort by applying an appropriate definition for PE and validated outcome measures of depression.MethodsA total of 956 males (≥20 years) were initially approached via an Internet survey company. Participants were asked to complete a questionnaire requesting detailed medical and sexual histories, which included questions from the Erectile Function Domain score in the International Index of Erectile Function (IIEF‐EF) and the Beck Depression Inventory (BDI). The prevalence of PE was evaluated using two different definitions—self‐assessed PE and presumed PE. Presumed PE was defined as a short ejaculation time (an estimated intravaginal ejaculatory latency time ≤5 minutes), an inability to control ejaculation, and the presence of distress resulting from PE.Main Outcome MeasuresEjaculation‐related questionnaire, the IIEF‐EF, and BDI.ResultsA total of 334 men were evaluated. The prevalence of PE was 10.5% according to the Presumed PE definition, whereas by self‐assessment, it was 25.4%. Self‐assessed PE patients suffered from various psychological problems, such as depression, low self‐esteem, bother, and low sexual satisfaction. Even after excluding erectile dysfunction (ED) subjects, a significant relationship was found between self‐assessed PE and depression. Moreover, after further classification of the Self‐assessed PE group, we found that subjects included in this group, but not in the Presumed PE group, suffered more from psychological burden than any other members of the cohort.ConclusionKorean men with subjective perceptions of PE are prone to various psychological problems, which include depression. Son H, Song SH, Lee J‐Y, and Paick J‐S. Relationship between premature ejaculation and depression in Korean males. J Sex Med 2011;8:2062–2070.     

High‐Intensity Physical Activity,Stable Relationship,and High Education Level Associate with Decreasing Risk of Erectile Dysfunction in 1,000 Apparently Healthy Cardiovascular Risk Subjects

IntroductionErectile dysfunction (ED) is especially common in men with cardiovascular diseases (CVDs). However, the data are scarce concerning populations without manifested CVD.AimThe aim of this study was to describe factors associated with ED, especially those associated with decreasing risk of ED, in men with cardiovascular risk factors but without CVD, diabetes, or chronic renal disease.MethodsIn 2004 to 2007, a cross‐sectional population‐based sample of men 45 to 70 years old in two rural towns in Finland was collected. Men with previously diagnosed CVD, diabetes, or kidney disease were not invited to the study. In total 1,000 eligible men with cardiovascular risk factors, i.e., central obesity, high scores in the Finnish Diabetes Risk Score, high blood pressure, antihypertensive medication, or family history of coronary heart disease, myocardial infarction, or stroke, were included in the analysis. Questionnaires, clinical measurements, and laboratory tests were obtained. The prevalence of ED was studied comparing the means, and risk factors were studied using multivariate logistic regression analysis.Main Outcome MeasuresThe rate of ED was defined by the International Index of Erectile Function short form (IIEF‐5) and by two questions (2Q) about the ability to achieve and to maintain an erection.ResultsThe prevalence of ED was 57% or 68% using IIEF‐5 or 2Q, respectively. Age (odds ratio [OR]: up to 9.16; 95% confidence interval [CI], 5.00–16.79; P < 0.001), smoking (OR: 1.41; 95% CI, 1.04–1.91; P = 0.028), depressive symptoms (OR: 4.04 for moderate and severe; 95% CI,1.22–13.45; P = 0.001), high‐intensity physical activity (OR: 0.50; 95% CI, 0.29–0.86; P = 0.045), high education (OR: 0.52; 95% CI, 0.33–0.83; P = 0.013), and stable relationship (OR: 0.43; 95% CI, 0.21–0.88; P = 0.046) were associated with ED.ConclusionsIn apparently healthy men with cardiovascular risk factors, decreasing risk of ED is associated with high‐intensity physical activity, stable relationship, and high education level. Ettala OO, Syvänen KT, Korhonen PE, Kaipia AJ, Vahlberg TJ, Boström PJ, and Aarnio PT. High‐intensity physical activity, stable relationship, and high education level associate with decreasing risk of erectile dysfunction in 1,000 apparently healthy cardiovascular risk subjects. J Sex Med 2014;11:2277‐2284.     

Erectile Dysfunction Is More Common in Young to Middle‐Aged HIV‐Infected Men than in HIV‐Uninfected Men

IntroductionErectile dysfunction (ED) is common among elderly men and patients suffering from chronic diseases, the latter probably including also HIV infection. No studies, however, compared the prevalence of ED in HIV‐infected and HIV‐uninfected individuals using the International Index of Erectile Function (IIEF‐15).AimThe aim of this study is to compare ED prevalence in young to middle‐aged men with and without HIV infection using the IIEF‐15 questionnaire.MethodsWe conducted a cross‐sectional, observational, controlled study on 444 HIV‐infected men and 71 HIV‐uninfected men.Main Outcomes MeasuresThe IIEF‐15 questionnaire was used to assess ED. A cutoff score of ≤25 of the erectile domain was used to diagnose ED. Serum testosterone, demographic, and anthropometric (weight, height, and body mass index [BMI]) characteristics were obtained from all participants. Statistics included the T‐test, the Fisher's test, univariable and multivariable logistic regression, and univariate and multivariate Spearman's correlation analysis.ResultsThe HIV‐uninfected group was significantly younger than the HIV‐infected group and presented a higher BMI (P < 0.001). The prevalence of mild, moderate, and severe ED was higher in HIV‐infected men than in HIV‐uninfected men of all decades of age. In univariate analysis, HIV infection was associated with ED (odds ratio [OR] = 34.19, P < 0.001). In multivariable logistic regression analysis, HIV infection remained the strongest predictors of ED (OR = 42.26, P < 0.001) followed by hypogonadism, after adjusting for age and BMI.ConclusionsThis study demonstrates a clear association between ED and HIV infection, after adjusting for age and BMI. Other than HIV infection, hypogonadism was associated with ED. In addition, the prevalence of ED was higher in HIV‐infected men than in HIV‐uninfected men, in all decades of age. The early onset of ED in HIV‐infected men could be considered a peculiar clinical hallmark of HIV and confirms precocious aging in these patients. ED should be of concern to clinicians when managing HIV‐infected men even if the latter are young or middle aged. Zona S, Guaraldi G, Luzi K, Beggi M, Santi D, Stentarelli C, Madeo B, and Rochira V. Erectile dysfunction is more common in young, middle‐aged HIV‐infected men than in HIV‐uninfected men. J Sex Med 2012;9:1940–1947.     

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.     

The Effect of Statins on Erectile Dysfunction: A Meta‐Analysis of Randomized Trials

IntroductionErectile dysfunction (ED) is common in older men, especially those with comorbidities such as diabetes and atherosclerotic disease, conditions where statins are frequently prescribed.AimTo examine the effect of statin therapy on ED using the five‐item version of the International Inventory of Erectile Function (IIEF).MethodsWe performed a random‐effects meta‐analysis of studies identified by a systematic search of MEDLINE, Web of Knowledge, the Cochrane Database, and ClinicalTrials.gov. Examination of the 186 retrieved citations resulted in the selection of 11 randomized trials for inclusion in the meta‐analysis.Main Outcome MeasuresChange in the IIEF score.ResultsIIEF increased by 3.4 points (95% CI 1.7–5.0, P = 0.0001) with statins compared to control. This effect remained statistically significant after multiple sensitivity analyses, including analysis for publication bias, a cumulative meta‐analysis, and 11 repeated analyses with each study omitted sequentially. The increase in IIEF with statins was approximately one‐third to one‐half of that previously reported with phosphodiesterase‐5 inhibitors and larger than the effect of lifestyle modification. Metaregression showed an increase in benefit with decreasing lipophilicity. The average age of participants and the degree of LDL cholesterol lowering did not alter the effect on IIEF.ConclusionStatins cause a clinically relevant improvement of erectile function as measured by the five‐item version of the IIEF. Kostis JB and Dobrzynski JM. The effect of statins on erectile dysfunction: A meta‐analysis of randomized trials. J Sex Med 2014;11:1626–1635.     

The Efficacy of PDE5 Inhibitors Alone or in Combination with Alpha‐Blockers for the Treatment of Erectile Dysfunction and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Systematic Review and Meta‐Analysis

IntroductionErectile dysfunction (ED) and lower urinary tract symptoms (LUTS) are both highly prevalent in aging men. Alpha‐blockers and PDE‐5 inhibitors are widely used for the treatment of LUTS/benign prostatic hyperplasia (BPH) and ED.AimThe purpose of this meta‐analysis was to evaluate the efficacy of phosphodiesterase type 5 (PDE5) inhibitors alone or in combination with alpha‐blockers for the treatment of ED and LUTS.MethodsThe databases MEDLINE, EMBASE, PubMed, the Cochrane Controlled Trial Register of Controlled Trials, and the Chinese Biological Medical Database were searched to identify randomized controlled trials that referred to the use of a combination of PDE5 inhibitors and alpha‐blockers for the treatment of ED and LUTS associated with BPH. A systematic review and meta‐analysis was conducted.Main Outcome MeasuresInternational Prostate Symptom Score (IPSS), the maximum flow rate (Qmax), and International Index of Erectile Function‐Erectile Function (IIEF‐EF) domain score were used in this meta‐analysis.ResultsSeven publications involving 515 patients were included in the meta‐analysis. In the analysis, we found significantly improved IIEF, IPSS, and Qmax values in the combination use group compared with the use of PDE5 inhibitors alone (P = 0.04, 0.004, 0.007, respectively).ConclusionsThe combined use of PDE5 inhibitors and alpha‐blockers results in additive favorable effects in men with ED and LUTS suggestive of BPH compared with PDE5 inhibitor monotherapy. The alpha‐blockers may enhance the efficacy of the PDE5 inhibitors, which is beneficial for the treatment of ED and LUTS. Yan H, Zong H, Cui Y, Li N, and Zhang Y. The efficacy of PDE5 inhibitors alone or in combination with alpha‐blockers for the treatment of erectile dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia: A systematic review and meta‐analysis. J Sex Med 2014;11:1539–1545.