Hypertension, erectile dysfunction, and occult sleep apnea

Sleep-related respiratory pattern was evaluated in 175 hypertensive and 110 normotensive men, none of whom reported difficulties in initiating or maintaining sleep. Patients were grouped according to sexual status (complaint of erectile problems), hypertension treatment status (treated or untreated), and blood pressure (diastolic less than 90 or greater than or equal to 90). The prevalence of sleep apnea, apnea index, duration of the longest episode of apnea, and penile rigidity were tabulated. The group with elevated blood pressure, persistent even with antihypertensive drug therapy, had the most sleep apnea. The treated hypertensive men with controlled blood pressure had significantly less apnea than those whose blood pressure remained high. Untreated hypertensive groups, however, did not differ from normotensive groups with respect to apnea. Evidence of abnormal sleep-related respiratory activity was found in both hypertensive and normotensive groups with erectile problems. Interestingly, penile rigidity was significantly lower for hypertensive men with erectile complaints than for normotensive men with erectile complaints. There was also a small, but significant, negative correlation between apnea index and penile rigidity among men with erectile complaints. These results indicate that sexual status is an important consideration in the diagnosis of hypertension and sleep apnea. Moreover, these data suggest an interrelationship among hypertension, erectile dysfunction, and sleep apnea.     

Diabetes, erectile dysfunction, and sleep-related erections

Sleep-related erections were assessed in conjunction with polysomnography in 100 diabetic and 400 nondiabetic men with complaints of erectile problems. We also measured bulbocavernosus reflex latency, heart rate response to deep breathing, postural-related blood pressure changes, penile arterial sufficiency, and brachial blood pressures. To investigate the relationship between diabetes and erectile capacity, the results obtained from men with and without diabetes were compared. Men with diabetes had fewer sleep-related erections, less tumescence time, diminished penile circumference increase, and lower penile rigidity than nondiabetic men. These diabetes-related differences were found regardless of the maximum penile rigidity observed. The diabetic group had less heart rate response to deep breathing and lower penile blood pressures than the nondiabetic group, but only among men with maximum penile rigidity less than 500 g. These data indicate that both neurological and vascular mechanisms are involved to a greater degree in organic diabetic impotence than in the organic erectile dysfunction that occurs in nondiabetic men. Finally, the pattern of lower values for measures of nocturnal tumescence among diabetic men, compared to nondiabetic men, occurred in all age groups, except the oldest. Among impotent men, age 65 years or older, no difference was found between men with and without diabetes. This suggests that diabetes may foreshadow some of the age-related pathophysiological processes associated with erectile dysfunction.     

Female sexual dysfunction: the important points to remember

Media exposure regarding male sexual dysfunction and the growing number of viable treatment alternatives for erectile dysfunction has resulted in increasing numbers of men seeking clinical appointments and treatment for the condition, which has previously been considered taboo. Because these problems usually arise within the context of relationships, some investigators have alluded to increased rates of sexual dysfunction among the partners of these men. Also, since general practitioners, gynaecologists, geriatrists, and urologists are also seeing female patients for evaluation of various types of dysfunction, certain groups of these women with underlying chronic conditions have been noted to have high rates of concomitant sexual dysfunction. Physicians who have good rapport with these patients are in a privileged position to help with these intimate problems, which are often difficult for patients to discuss. Therefore, it is of extreme importance that these professionals become knowledgeable about and comfortable with the initial evaluation and possible treatment of female sexual dysfunction.     

Erforschung der Epidemiologie von männlichen Sexualstörungen in Deutschland

Purpose. The aim of the present study was to evaluate the epidemiology of male sexual disorders in Germany and the proportion of men who will need appropriate medical treatment. Material and methods.: The “ Kölner Fragebogen zur Erfasssung der erektilen Dysfunktion” (Cologne questionnaire on erectile dysfunction) was mailed to a representative population sample of 8000 men 30–80 years of age in the district of Cologne.These results were applied to the data on population development. Results. The response included 4489 evaluable replies (56.1%). Regular sexual activity was reported by 96.0% (youngest age group) to 71.3% (oldest group).Of the responders,31.5–44% were dissatisfied with their current sex life.The prevalence of ED was 19.2% (affected), with a steep age-related increase (2.3–53.4%) and a high comorbidity of ED with hypertension, diabetes, pelvic surgery, and lower urinary tract symptoms. The necessity for treatment (defined by co-occurrence of ED and dissatisfaction with sex life) was 6.9%. Conclusions. In the “Cologne 8000 men survey” we were able to show that not every man with provable erectile dysfunction needs medical therapy.The number of men seeking ED therapy calculated by the health insurance providers was overestimated. Demographic changes will lead to an increase in the number of ED patients.     

Pituitary-gonadal function during sleep in men with hypoactive sexual desire and in normal controls

There is virtually no information on the psychobiology of hypoactive sexual desire (HSD) in men. This study compares pituitary and gonadal hormones and nocturnal penile tumescence (NPT) during sleep in 17 physically healthy men with HSD and 17 age-matched, nondysfunctional volunteers. There were six HSD men with problems of sexual arousal and 11 with secondary erectile impotence. The subjects, aged 27-55, were studied in a sleep laboratory for 4 nights with the last night devoted to sequential blood sampling every 20 min. The total group of HSD men had significantly lower plasma testosterone, measured hourly through the night, than controls, and there was a positive relation between testosterone and frequency of sexual behavior. There were no differences in free testosterone, prolactin, luteinizing hormone (LH), and estradiol between the HSD and control groups. The NPT parameters of HSD men with secondary impotence were consistently and significantly lower than the nondysfunctional men. These data are discussed with respect to the role of gonadal hormones in male sexual function, the significance of NPT as a window to central biologic events, and to possible heterogeneity of men with hypoactive sexual desire.     

Male sexual function after autologous blood or marrow transplantation.

Although endocrine dysfunction has been reported in survivors of allogeneic bone marrow transplantation (alloBMT), data for autologous BMT (autoBMT) recipients are lacking. Because information on male potency in particular is scanty, we prospectively assessed male sexual function after autoBMT. We identified 16 men who were < or =50 years of age at the time of evaluation and disease free for at least 6 months after autoBMT. Nine had Hodgkin's disease, 4 had acute myelogenous leukemia, and 3 had non-Hodgkin's lymphoma. Blood samples were assayed for luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone. Patients were surveyed with a modified version of the Pyschosocial Adjustment to Illness Scale regarding erectile dysfunction and loss of interest in sexual activities. Seventy five percent of the men reported normal interest in sexual activities and 87.5% reported normal erectile function; however, 4 of 16 reported a moderate loss of interest in sexual activities, and another 2 of 16 reported frequent loss of erectile function. All 4 men with decreased libido and both men with impaired erectile function had Hodgkin's disease. Fourteen (88%) of 16 patients had an elevated FSH level, 7 (47%) of 15 had elevated LH, and 6 (38%) of 16 had decreased testosterone levels. Decreased testosterone levels correlated with a moderate or total loss of libido (P = .008) and a diagnosis of Hodgkin's disease (P = .01). Thus, after transplantation, most men have abnormal levels of gonadotrophins. Decreased levels of testosterone and symptoms of sexual dysfunction correlated with a diagnosis of Hodgkin's disease and may be related to the induction and salvage therapy received prior to autoBMT.     

Frequency of sexual dysfunction in "normal" couples

In analyzing the responses of 100 predominantly white, well educated and happily married couples to a self-report questionnaire, this study examined the frequency of sexual problems experienced and the relations of those problems to sexual satisfaction. Although over 80 per cent of the couples reported that their marital and sexual relations were happy and satisfying, 40 per cent of the men reported erectile or ejaculatory dysfunction, and 63 per cent of the women reported arousal or orgasmic dysfunction. In addition, 50 per cent of the men and 77 per cent of the women reported difficulty that was not dysfunctional in nature (e.g., lack of interest or inability to relax). The number of "difficulties" reported was more strongly and consistently related to overall sexual dissatisfaction than the number of "dysfunctions."     

A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men

BACKGROUND: Depression and erectile dysfunction (ED) have a complex and bi-directional relationship. We examined the relationships between erectile dysfunction and depressive symptoms or diagnosed depression, sexual activity and sexual satisfaction. METHODS: A population survey of men aged 40-70 years was carried out in Brazil, Italy, Japan and Malaysia in 1997-1998. A questionnaire was used to collect life style, sexual behaviors and medical data. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. ED was classified as moderate or complete if the men reported they were "sometimes" or "never" able to achieve and maintain an erection satisfactory for sexual intercourse. Only men with a sexual partner and not taking psychoactive drugs were considered. RESULTS: Diagnosed depression was reported by 2.0% of the men, depressive symptoms by 21.0%. The prevalence of moderate or complete ED was 17.8%. Sexual satisfaction related to the frequency of sexual intercourse and inversely related to depressive symptoms. Depressive symptoms were positively associated with being single (odds ratio [OR] 1.7), widowed, separated or divorced (OR 2.2), moderate or complete ED (1.8), heart disease (1.6) and smoking (1.6), and negatively associated with age, physical activity and frequency of sexual intercourse. LIMITATIONS: Cross-sectional studies cannot establish a temporal cause-effect relationship. However, the confirmation of known associations reassures about the validity of the original findings. CONCLUSIONS: The findings suggest that depressive symptoms are linked to ED by the mediation of decreased sexual activity and the dissatisfaction generated by the inability to have a healthy sexual life.     

The relationship between pituitary-gonadal function and sexual behavior in healthy aging men

Few studies have assessed the role of pituitary and gonadal hormones on age-related changes in sexual behavior in healthy men. We conducted a retrospective and prospective evaluation of sexual function and behavior in 77 healthy married men aged 45 to 74 years. The subjects were studied in the sleep laboratory for four nights with the last night devoted to sequential blood sampling every 20 minutes. Significant age-related decreases in sexual desire, sexual arousal and activity, and increases in erectile problems were noted. Aging was negatively correlated with bioavailable testosterone (bT), was positively correlated with luteinizing hormone (LH), and was not related to total testosterone, estradiol, and prolactin. Bioavailable testosterone, and the ratio of bT over LH showed a close association with several sexual behavior dimensions while total testosterone, estradiol, and prolactin demonstrated few or no behavioral relationships. The age-related effect of bT was, however, a more important determinant of the reported behavioral differences than were the effect of bT independent of age. There was no evidence that changes in circulating hormones contribute to erectile disorders in healthy aging men.     

Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials

BACKGROUND: This review was undertaken to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication. METHODS: Electronic databases and reference lists were searched, and pharmaceutical companies and experts contacted to identify randomised controlled trials comparing management strategies for antidepressant-induced sexual dysfunction. RESULTS: Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 to 0.6). Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF) (WMD 19.36, 95% CI 15.00 to 23.72). Another trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 to 1.55). In a further study the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo. DISCUSSION: The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.     

Depressive symptomatology and male sexual functions in late life

BACKGROUND: We aimed to investigate the association between depressive symptoms and various male sexual functions, and to identify which depressive symptoms are most predictive of erectile dysfunction (ED). METHODS: This was an analytic cross-sectional study with 160 sexually active men aged 50 or above recruited from a large primary care treatment centre. The 5 domains (erectile function, EF; intercourse satisfaction, IS; orgasmic function, OF; sexual desire, SD; overall satisfaction, OS) of the International Index of Erectile Function (IIEF-15) were used to assess various sexual functions. Depressive symptomatology was measured by Geriatric Depression Scale and reconfirmed with General Health Questionnaire. RESULTS: The level of depressive symptoms was negatively associated with erectile function (p<0.01), orgasmic function (p=0.02), intercourse satisfaction (p=0.04) and overall satisfaction (p<0.01), and was independent of age, education and number of health conditions, but was not associated with sexual desire (p=0.97). Erectile dysfunction was significantly associated with age (OR=1.12; 95% CI 1.05-1.19; p<0.01) and level of depressive symptoms (OR=1.39; 95% CI 1.05-1.85; p=0.02) after multivariate adjustment. In particular, only "low mood" (p=0.03) and "worthlessness" (p=0.03) remained positively associated with ED after multivariate adjustments. LIMITATIONS: Cross-sectional design cannot demonstrate direction of causality. CONCLUSIONS: We are the first to implicate "low mood" and "worthlessness" in the association between depressive symptoms and ED, and this is the first study to investigate the association in Chinese.     

Male reproductive physiology as a sexually selected handicap? Erectile dysfunction is correlated with general health and health prognosis and may have evolved as a marker of poor phenotypic quality

Many extravagant physical traits are selected because they are used as cues for mate choice (sexual selection). Why is mate choice driven by costly ornaments? A theory of sexual selection posits that extravagant traits are preferred because are reliable indicators of superior (heritable) phenotypic quality. In particular, the preferred traits can be expressed only in individuals with superior conditions because are handicaps which impose a high cost to the carrier. The human penis achieves its reproductive function by the complex neuro-vascular mechanisms that controls erection. Surprisingly, erectile dysfunction and infertility, two condition which nearly annihilate fitness, are widespread medical conditions which affect millions of people of any age worldwide. The very high incidence of erectile dysfunction appears as an evolutionary paradox. Impotence is associated with all major systemic diseases as well depression and stress. Stress is also one of the causes of infertility. Therefore, male reproduction appears to be extremely sensitive to internal and external stressors. Moreover, erectile dysfunction is a predictor of myocardial infarction and stroke, whereas men with regular sexual activity have lower risk of death due to coronary disease. This large body of medical literature makes erection the best case for a fitness indicator in the human male. We suggest that the fragility of male sexual physiology observed in modern society is the specific consequence of an evolutionary process driven by the handicap principle.     

Prevalence of erectile and ejaculatory difficulties among men in Croatia

Aim

To determine the prevalence and risk factors of erectile difficulties and rapid ejaculation in men in Croatia.

Method

We surveyed 615 of 888 contacted men aged 35-84 years. The mean age of participants was 54 ± 12 years. College-educated respondents and the respondents from large cities were slightly overrepresented in the sample. Structured face-to-face interviews were conducted in June and July 2004 by 63 trained interviewers. The questionnaire used in interviews was created for commercial purposes and had not been validated before.

Results

Out of 615 men who were sexually active in the preceding month and gave the valid answers to the questions on erectile difficulties and rapid ejaculation, 130 suffered from erectile or ejaculatory difficulties. Men who had been sexually active the month before the interview and gave the valid answers to the questions on sexual difficulties reported having erectile difficulties more often (77 out of 615) than rapid ejaculation (57 out of 601). Additional 26.8% (165 out of 615) and 26.3% (158 out of 601) men were classified as being at risk for erectile difficulties and rapid ejaculation, respectively. The prevalence of erectile difficulties varied from 5.8% in the 35-39 age group to 30% in the 70-79 age group. The association between age and rapid ejaculation was curvilinear, ie, U-shaped. Rates of rapid ejaculation were highest in the youngest (15.7%) and the oldest (12.5%) age groups. Older age (odds ratios [OR], 6.2-10.3), overweight (OR, 3.3-4.2), alcohol (OR, 0.3-0.4), intense physical activity (OR, 0.3), traditional attitudes about sexuality (OR, 2.8), and discussing sex with one’s partner (OR, 0.1-0.3) were associated with erectile difficulties. Education (OR, 0.1-0.3), being overweight (OR, 22.0) or obese (OR, 20.1), alcohol consumption (OR, 0.2-0.3), stress and anxiety (OR, 10.8-12.5), holding traditional attitudes (OR, 2.8) and moderate physical activity (OR, 0.1) were factors associated with rapid ejaculation.

Conclusion

The prevalence of erectile difficulties was higher than the prevalence of rapid ejaculation in men in Croatia. The odds of having these sexual difficulties increased with older age, overweight, traditional attitudes toward sex, and higher level of stress and anxiety.A growing number of international studies on sexual health issues suggest that many women and men worldwide have sexual health problems (1-4). According to surveys based on community samples, the prevalence of male sex disturbances ranges between 10% and 50% (2,4). The most frequent male sexual disturbance seems to be premature or rapid ejaculation (5,6), reported to range from 4% to 29% (6). The Global Study of Sexual Attitudes and Behaviors estimated the prevalence of rapid ejaculation at approximately 30% across all age groups (7). Actually, it seems to be the most common of all male sexual disturbances (5-9). However, when objective definition of rapid ejaculation is attempted, problems arise (9,10). According to the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), rapid ejaculation is a persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the person wishes it (11). It results in pronounced distress or interpersonal difficulties and is not exclusively due to the direct effects of a substance used (11). Although useful for clinical practice, this definition does not offer precise guidelines for epidemiological research. As indicated by large discrepancies in the prevalence rates (6), epidemiological analyses of rapid ejaculation are characterized by definition and measurement inconsistencies (1,10,12).In spite of the lack of agreement as to what constitutes rapid ejaculation (12) and the fact that it is not a well-understood problem (5,13), the consequences are well known. Chronic rapid ejaculation is accompanied by an array of psychological problems, including a psychogenic erectile dysfunction (14). Rapid ejaculation can seriously burden interpersonal dynamics and decrease sexual satisfaction (15) and sometimes the overall quality of intimate relationship (16,17). In addition to frustrations, withdrawal (including the lack of desire and cessation of sexual contacts), and strained relationship, rapid ejaculation causes changes in self-image and one’s sense of masculinity. It has been shown that rapid ejaculation has similar psychological impact as erectile problems, especially in terms of self-confidence and worries over the relationship, both the present and the future ones (14).Psychologically and culturally, erectile difficulties are the most dreaded male sexual problem (16,18,19), which not only result in deep frustration, but often lead to a crisis of masculine identity (19). Recent pharmacological breakthrough has initiated a rapid growth of interest in the epidemiology of erectile difficulties. Current studies suggest that a sizeable proportion of adult men suffer from erectile difficulties and that the likelihood of erectile difficulties increases with age (1-4). According to a recently published systematic review, the prevalence of erectile difficulties ranges from 2% in men younger than 40 years to over 80% in men aged 80 years or more (4). Due to the aging of population, the number of men with erectile difficulties is expected to be rising (20,21). The projection based on the results of the Massachusetts Male Aging Study (MMAS) from 1995 is that the number of men with the condition will more than double by 2025 (22).How do we explain considerable variations in reported prevalence rates of erectile difficulties? Methodological and conceptual differences between the studies (1,3,4,23) seem to be the main reason, although the effect of culture-specific perception of sexual problems should not be underestimated (24). In spite of a large number of population or community sample studies (18,20,25-38), inconsistent definitions and operationalization seriously hamper the analysis of the role of culture in perception and reporting of erectile difficulties in men.In transitional countries, sexual health is a rather neglected research area. The main reason for that is the lack of education and research training of possible investigators in the field of sexology. In Croatia, sexual health issues have only recently gained attention as a topic worthy of clinical (39) and non-clinical research (40,41). Our aim was to determine the prevalence of and risk factors for erectile difficulties and rapid ejaculation in a national sample of Croatian men.     

Benefits and risks of testosterone treatment for hypoactive sexual desire disorder in women: a critical review of studies published in the decades preceding and succeeding the advent of phosphodiesterase type 5 inhibitors

With advancing age, there is an increase in the complaints of a lack of a libido in women and erectile dysfunction in men. The efficacy of phosphodiesterase type 5 inhibitors, together with their minimal side effects and ease of administration, revolutionized the treatment of erectile dysfunction. For women, testosterone administration is the principal treatment for hypoactive sexual desire disorder. We sought to evaluate the use of androgens in the treatment of a lack of libido in women, comparing two periods, i.e., before and after the advent of the phosphodiesterase type 5 inhibitors. We also analyzed the risks and benefits of androgen administration. We searched the Latin-American and Caribbean Health Sciences Literature, Cochrane Library, Excerpta Medica, Scientific Electronic Library Online, and Medline (PubMed) databases using the search terms disfunção sexual feminina/female sexual dysfunction, desejo sexual hipoativo/female hypoactive sexual desire disorder, testosterona/testosterone, terapia androgênica em mulheres/androgen therapy in women, and sexualidade/sexuality as well as combinations thereof. We selected articles written in English, Portuguese, or Spanish.After the advent of phosphodiesterase type 5 inhibitors, there was a significant increase in the number of studies aimed at evaluating the use of testosterone in women with hypoactive sexual desire disorder. However, the risks and benefits of testosterone administration have yet to be clarified.     

The impact of menopause on sexual function in women and their spouses

BackgroundThe purpose of this study is to evaluate the impact of menopause on sexual function in women and their spouses.MethodsThis is a cross-sectional study that was conducted from January 2018 to May 2019 in Rasht (North of Iran). The participants included 215 menopausal women and their spouses. Data were collected using the demographic questionnaire, the Female Sexual Function Index (FSFI) questionnaire, and the International Index of Erectile Function (IIEF) questionnaire.ResultsOn the basis of the FSFI and IIEF scores, 36.28% (78/215) women reported female sexual dysfunction (FSD) and 17.2% (37/215) men reported erectile dysfunction (ED) with 8.37% (N = 18) being mild, 5.58% (N = 12) mild to moderate, and 3.25% (N = 7) moderate ED. After adjusting differences in the female age distribution, the total score and scores of the IIEF subscales were also not significantly lower in the spouses of women with FSD than women without FSD.ConclusionAlthough, significant correlations between male erectile function and menopausal female sexual function have not identified; but, low scores of the subscales of FSFI in female participants mostly impaired sexual satisfaction and overall satisfaction in their spouses.     

Noradrenergic innervation of the penis in control and streptozotocin-diabetic rats: evidence of autonomic neuropathy

The noradrenergic sympathetic innervation of the penis of control and 4-month streptozotocin-diabetic rats was examined with the glyoxylic acid histofluorescence method. Noradrenergic varicosities were found in the corpora cavernosa in a dense subtunical plexus and in the perisinusoidal and trabecular regions of the erectile tissue, in the corpus spongiosum in perisinusoidal tissue, around large arteries and veins, and around small tortuous arterioles and small draining veins of the corpora cavernosa and spongiosum. Noradrenergic varicosities were diminished in number and fluorescent intensity in all regions of the penis of diabetic rats compared with controls. The subtunical plexus was absent, perisinusoidal and trabecular varicosities were sparse, and only occasional intermittent, discontinuous, dull fluorescent fibers or plexuses were found around the vessels. Quantitation with high-performance liquid chromatography revealed a significant reduction of norepinephrine in the penis of diabetic rats compared with controls. The present study suggests that long-term streptozotocin diabetes in the rat is accompanied by sympathetic autonomic neuropathy of the penis that seems to parallel changes in the noradrenergic content of penile corpora of men with diabetes and erectile impotence. The streptozotocin-diabetic rat merits further study to explore the relationship between noradrenergic innervation of the penis and erectile tissue.     

Perceptions of well-being in sexual ill health: what role does age play?

This article explores the ways in which age can mediate the impact of sexual health problems on psychological well-being, and reports a qualitative interview study with 69 participants (aged 31-92). Data were analysed using 'Framework' and the following themes identified. Participants self-defined their sexual health problems, and these included tiredness, erectile dysfunction and menopause. Older participants reported more physical conditions of a long-term nature and younger participants experienced more shorter-term problems. The effect these had on the sufferer varied with regard to perceived aetiology and longevity of the problem, for instance older participants perceived some problems as age-related which buffered impact on well-being. The findings are discussed in relation to their implications for health care and policy development.     

Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction.

BACKGROUND: The pelvic floor muscles are active in normal erectile function. Therefore, it was hypothesised that weak pelvic floor muscles could be a cause of erectile dysfunction.AIMS: To compare the efficacy of pelvic floor muscle exercises and manometric biofeedback with lifestyle changes for men with erectile dysfunction.Design of study: Randomised controlled trial.SETTING: The Somerset Nuffield Hospital, Taunton, United Kingdom.METHOD: Fifty-five men with erectile dysfunction (median age 59.2 years; range 22-78 years) were enrolled from a local urology clinic. Of these, 28 participants were randomised to an intervention group and engaged in pelvic floor exercises, as well as receiving biofeedback and suggestions for lifestyle changes. Twenty-seven controls were solely advised on lifestyle changes. Baseline, 3- and 6-month assessments were: erectile function domain of International Index of Erectile Function (IIEF), Partner's International Index of Erectile Function (PIIEF), Erectile Dysfunction-Effect on Quality of Life (ED-EQoL), anal manometry, digital anal measurements, and clinical assessment by an assessor blind to treatment allocation. After 3 months, the control group were transferred to the active arm.RESULTS: At 3 months, compared with controls, men in the intervention group showed significant mean increases in the erectile function domain of the IIEF (6.74 points, P = 0.004); anal pressure (44.16 cmH(2)O, P <0.001); and digital anal grades (1.5 grades, P <0.001). All showed further improvement in these outcomes at 6 months. Similar benefits were seen in men of the control arm after transfer to active treatment. A total of 22 (40.0%) participants attained normal function, 19 (34.5%) participants had improved erectile function, and 14 (25.5%) participants failed to improve.CONCLUSION: Pelvic floor muscle exercises and biofeedback are an effective treatment for men with erectile dysfunction.     

A Comparative Study of Sexual Experiences: Women with Diabetes and Women with Congenital Adrenal Hyperplasia due to 21-hydroxylase Deficiency

There has been little detailed study of the sexual outcome of women suffering from congenital adrenal hyperplasia, a condition which results in masculinization of the external genitalia and possible genital ambiguity at birth in chromosomal females. This study, combining qualitative and quantitative methods, reports the sexual outcome for a sample of women with congenital adrenal hyperplasia (CAH; N = 19), compared to that for an age-matched sample of women with early diagnosed diabetes (N =17). The results are given under the headings of sexual interest; sexual activity with partners; reasons for engaging in sexual behaviour; sexual activities; stimuli eliciting a sexual response; physical problems connected with sexual activities, and general issues. CAH women were found to be less sexually experienced in all areas, and reported higher levels of penetration difficulties, pain, and lubrication problems than the diabetic women. It is proposed that the contribution of psychological factors to these problems may be at least as great as that of medical/ surgical factors. Implications for management are considered.     

Prevalence of sexual dysfunctions and associated risk factors in Poland

IntroductionMany biological, psychological and sociocultural factors influence the prevalence of sexual dysfunctions and sexual behavior. The purpose of the study was to evaluate the prevalence of sexual dysfunctions and sexual behaviors.Material and methodsThe study was the third edition of a general population-based, cross sectional survey, evaluating sexual attitude, sexual behaviors within and outside relationships and type of sexual dysfunctions present in the Polish population. The survey consisted of 82 questions, grouped into five blocks that contained open- and closed-ended general questions, inquiries about early sexual contacts, sex life, relationships, sexual behaviors and preferences. A standard questionnaire was used to obtain data on age, education, marital status, religious beliefs, medical history, disabilities and other illnesses. A total of 1054 responders aged from 18 to over 70 years participated in the study. Risk factors and other causes contributing to certain sexual dysfunctions defined in the DSM-5 and in the available literature were analyzed.ResultsIn this research, 40% of women and 36.5% of men had at least one sexual dysfunction. Analysis of the total population showed that decreased sexual desire (29.0%), occasional climaxing (28.5%) and anorgasmia (21.0%) were the dysfunctions most frequently reported by women. In men, premature ejaculation (23%) and excessive sexual needs (16.3%) were most prevalent. Both men and women with arousal problems reported significantly more comorbid sexual dysfunctions (p < 0.001).ConclusionsSexual dysfunctions are highly prevalent in the Polish population. Of note, it is alarming that only very few patients seek professional help when sexual problems occur.