Erectile Dysfunction and Undiagnosed Diabetes,Hypertension, and Hypercholesterolemia

PURPOSEWe investigated whether erectile dysfunction, a marker for future cardiovascular disease, is associated with undiagnosed cardiometabolic risk factors among US men. Identifying the presence of these risk factors could lead to earlier initiation of treatment for primary prevention of cardiovascular disease.METHODSWe analyzed cross-sectional data from men aged 20 years and older who participated in the National Health and Nutrition Examination Survey during 2001–2004. Erectile dysfunction was determined by a single, validated survey question. We used logistic regression analyses to investigate the relationship between erectile dysfunction and undiagnosed hypertension, hypercholesterolemia, and diabetes.RESULTSAfter multivariate adjustment, men with erectile dysfunction had more than double the odds of having undiagnosed diabetes (odds ratio = 2.20; 95% CI, 1.10–4.37), whereas no association was seen for undiagnosed hypertension or undiagnosed hypercholesterolemia. For the average man aged 40 to 59 years, the predicted probability of having undiagnosed diabetes increased from 1 in 50 in the absence of erectile dysfunction to 1 in 10 in the presence of erectile dysfunction.CONCLUSIONSOur results underscore the importance of erectile dysfunction as a marker of undiagnosed diabetes. Erectile dysfunction should be a trigger to initiate diabetes screening, particularly among middle-aged men.     

糖尿病性勃起功能障碍大鼠模型的建立及阴茎海绵体组织nNOS的变化

目的研究糖尿病性勃起功能障碍(ED)大鼠模型的建立及阴茎海绵体组织nNOS表达活性的变化。方法1.24只SPF级SD雄性大鼠,随机分为4组,按不同处理因素给大鼠腹腔注射链脲佐菌素(STZ),分别记录4d、1周、2周、3周的体质量、阿朴吗啡(APO)诱导阴茎的勃起次数及空腹血糖值。2.40只SPF级SD雄性大鼠,先随机分为两组,一组注射STZ后观察7周,另一组注射STZ后观察4周,按照成模标准,将每一处理组又分为对照组、成糖尿病性勃起功能障碍模型组、成糖尿病性非勃起功能障碍组、未成模组。采用免疫组化SP法检测大鼠阴茎组织中nNOS的表达,利用彩色图文分析系统,测量随机每高倍镜视野下累积光密度(IOD),以IOD值反映组织切片中nNOS表达程度。结果1.体质量及空腹血糖在四个不同时间点和不同处理组间均有显著性差异(P均<0.001),注射STZ60mg/kg组体质量较轻、血糖较高。APO诱导阴茎勃起次数在四个不同组间有显著性差异(F=2.831,P=0.046),注射STZ60mg/kg组应用APO后阴茎未勃起的例数较多。2.注射STZ后4周与注射STZ后7周处理组各不同组别间IOD存在显著性差异(F=3.864,P=0.020),糖尿病性勃起功能障碍组IOD均小于对照组、糖尿病非勃起功能障碍组及未成模组(P<0.05)。结论1.大鼠注射STZ后两周,血糖>7.2mmol/L及APO诱导阴茎未勃起的,可认为是糖尿病性勃起功能障碍模型(DM&ED);2.糖尿病ED大鼠阴茎海绵体组织中nNOS表达量明显减少,这可能是糖尿病性勃起功能障碍的发病机理之一。     

糖尿病性勃起功能障碍大鼠模型的建立及阴茎海绵体组织nNOS的变化

目的研究糖尿病性勃起功能障碍（ED）大鼠模型的建立及阴茎海绵体组织nNOS表达活性的变化。方法1．24只SPF级SD雄性大鼠,随机分为4组．按不同处理因素给大鼠腹腔注射链脲佐菌素（STZ）,分别记录4d、1周、2周、3周的体质量、阿朴吗啡（APO）诱导阴茎的勃起次数及空腹血糖值。2．40只SPF级SD雄性大鼠,先随机分为两组,一组注射STZ后观察7周．另一组注射STZ后观察4周．按照成模标准,将每一处理组又分为对照组、成糖尿病性勃起功能障碍模型组、成糖尿病性非勃起功能障碍组、未成模组。采用免疫组化sP法检测大鼠阴茎组织中nNOS的表达,利用彩色图文分析系统,测量随机每高倍镜视野下累积光密度（IOD）．以IOD值反映组织切片中nNOS表达程度。结果1．体质量及空腹血糖在四个不同时间点和不同处理组间均有显著性差异（P均〈0．001）,注射STZ60mg／kg组体质量较轻、血糖较高。APO诱导阴茎勃起次数在四个不同组间有显著性差异（F=2．831,P=0．046）,注射STZ60mg／kg组应用APO后阴茎未勃起的例数较多。2．注射STZ后4周与注射STZ后7周处理组各不同组别间IOD存在显著性差异（F=3．864,P=0．020）,糖尿病性勃起功能障碍组IOD均小于对照组、糖尿病非勃起功能障碍组及未成模组（P〈0．05）。结论1．大鼠注射STZ后两周,血糖〉7．2mmol／L及APO诱导阴茎未勃起的,可认为是糖尿病性勃起功能障碍模型（DM＆ED）;2．糖尿病ED大鼠阴茎海绵体组织中nNOS表达量明显减少,这可能是糖尿病性勃起功能障碍的发病机理之一．     

Cigarette smoking and erectile dysfunction among Chinese men without clinical vascular disease

The authors examined the association between cigarette smoking and risk of erectile dysfunction among 7,684 Chinese men aged 35-74 years without clinical vascular disease. Cigarette smoking and erectile dysfunction were assessed by questionnaire. Vascular risk factors were measured according to standard methods. After adjustment for age, education, alcohol consumption, physical inactivity, diabetes, hypertension, overweight, and hypercholesterolemia, the odds ratio of erectile dysfunction was 1.41 (95% confidence interval (CI): 1.09, 1.81) for cigarette smokers compared with never smokers. There was a statistically significant dose-response relation between cigarette smoking and risk of erectile dysfunction (p(trend) = 0.005). Multivariate-adjusted odds ratios of erectile dysfunction were 1.27 (95% CI: 0.91, 1.77), 1.45 (95% CI: 1.08, 1.95), and 1.65 (95% CI: 1.08, 2.50) for those who smoked 1-10, 11-20, and more than 20 cigarettes per day, respectively, compared with never smokers. The association was stronger in participants with diabetes (odds ratio = 3.29, 95% CI: 1.49, 7.27) than in participants without diabetes (odds ratio = 1.33, 95% CI: 1.03, 1.73). If the association is causal, an estimated 22.7% of erectile dysfunction cases (11.8 million cases) among Chinese men are attributable to cigarette smoking. This 2000-2001 study of Chinese men documented an independent and dose-response relation between cigarette smoking and risk of erectile dysfunction.     

2型糖尿病小型猪勃起功能障碍及NOS变化

目的观察一氧化氮合酶(NOS)在糖尿病性勃起功能障碍中的作用。方法采用高脂高糖饮食喂养的方法建立广西巴马小型猪糖尿病性阴茎勃起功能障碍模型(DMED),对正常对照组(CD)和高脂高糖组(HFSD)动物于造模第12月后进行阿朴吗啡阴茎勃起实验,用酶联免疫吸附试验(ELISA)检测阴茎海绵体组织中NOS活性。结果 HFSD组动物空腹血糖和血清总胆固醇明显升高(P0.01),HFSD组动物阴茎勃起率较正常组明显降低(P0.01),NOS活性亦显著降低(P0.05)。结论糖尿病严重影响小型猪勃起功能,阴茎海绵体组织NOS活性的降低可能是其机理之一。     

From the Cochrane Library: Phosphodiesterase inhibitors are effective in treating erectile dysfunction in diabetic men

Erectile dysfunction is a common multifactorial complication of diabetes mellitus. In recent years, phosphodiesterase type 5 (PDE-5) inhibitors have been introduced in the management of erectile dysfunction. A recent Cochrane systematic review assessed the effects ofPDE-5 inhibitors in patients with diabetes mellitus and erectile dysfunction from 8 randomized placebo-controlled trials (a total of 1759 participants). The duration of therapy was mainly 12 weeks. The weighted mean difference (WMD) for the International Index of Erectile Function (erectile dysfunction domain) at the end of the study period was 6.6 in favour of the PDE-5 inhibitors arm. The relative risk for answering 'yes' to a global efficacy question ('did the treatment improve your erections?') was 3.8 in the PDE-5 inhibitors arm compared with the control arm. Headache and flushing were the most common adverse events, followed by flu-like symptoms, dyspepsia, myalgia, vision disorders and lower back pain. The overall risk ratio for developing any adverse reaction was 4.8 in the PDE-5 inhibitors arm as compared to the control arm. It was concluded that sufficient evidence exists that treatment with PDE-5 inhibitors can improve erectile dysfunction in diabetic men.     

Erectile function and risk of Parkinson's disease

Erectile dysfunction is common among individuals with Parkinson's disease, but it is unknown whether it precedes the onset of the classic features of Parkinson's disease. To address this question, the authors examined whether erectile dysfunction was associated with Parkinson's disease risk in the Health Professionals Follow-up Study. Analyses included 32,616 men free of Parkinson's disease at baseline in 1986 who in 2000 completed a retrospective questionnaire with questions on erectile dysfunction in different time periods. Relative risks were computed using Cox proportional hazards models adjusting for age, smoking, caffeine intake, history of diabetes, and other covariates. Among men who reported their erectile function before 1986, 200 were diagnosed with Parkinson's disease during 1986-2002. Men with erectile dysfunction before 1986 were 3.8 times more likely to develop Parkinson's disease during the follow-up than were those with very good erectile function (relative risk = 3.8, 95% confidence interval: 2.4, 6.0; p < 0.0001). Multivariate-adjusted relative risks of Parkinson's disease were 2.7, 3.7, and 4.0 (95% confidence interval: 1.4, 11.1; p = 0.008) for participants with first onset of erectile dysfunction (before 1986) at 60 or more, 50-59, and less than 50 years of age, respectively, relative to those without erectile dysfunction. In conclusion, in this retrospective analysis in a large cohort of men, the authors observed that erectile dysfunction was associated with a higher risk of developing Parkinson's disease.     

Evaluation of Erectile Dysfunction and Associated Factors in Type-II Diabetic Patients in Birjand, Iran in 2008-2009

Background: Erectile dysfunction (ED) is one of the important complications in diabetic patients. Various factors trigger the onset and intensity of erectile dys-function. This study was done to determine the prevalence of erectile dysfunction and some associated factors among type II-diabetic patients in Birjand, Iran. Methods: In this cross-sectional study, which was carried out in Birjand during 2008 and 2009, 171 male diabetic patients aged 29 to 76 years who were sex-ually active and had no history of prostate surgery were included. Data on demographic characteristic and history of diabetes was collected using a questionnaire. International Index of Erectile Dysfunction-5 and Beck's standard questionnaire were used to determine erectile dysfunction and depression, respectively. Data were analyzed using multiple statistical tests including chi square, t-test, and logistic regression. Results: The mean age of study population was 52.78 [95% CI: 51.25, 54.32] years (range between 29 to 76 years) and 43.3% of individuals were under 50 years. ED was diagnosed in 140 out of 171 (81.9%) diabetic patients. ED was mild in 28 (20%) subjects, moderate in 66 (47.1%), and sever in 46 (32.9%). Suffering from Long-term of diabetes (P<0.001), progressive depression (P<0.001), increased level of HbA(1)c (P<0.001), and decreased level of HDL (P<0.001) were among the most related factors with ED. Conclusion: The prevalence of ED is high among diabetic patients. Control of the disease and its relevant risk factors might be helpful in decreasing sexual dysfunction in diabetic patients.     

中医治疗勃起功能障碍相关研究进展

勃起功能障碍又称为阳痿,是临床中常见的一类男性泌尿生殖系统疾病。其临床特征主要为在性活动中无法出现或维持阴茎正常勃起。勃起功能障碍主要由激素缺乏、神经系统紊乱、缺乏足够的阴茎血供或心理问题等引起。目前治疗勃起功能障碍主要为西药磷酸二酯酶抑制剂,该药物可明显改善患者的阴茎充血达到正常勃起。但该药物需要长期服用或每次同房前使用,且具有头痛、颜面潮红等副作用。祖国传统中医药对勃起功能障碍有着深刻认识并积累了丰富的治疗经验。本文基于中医治疗勃起功能障碍角度,对于勃起功能障碍中医发病机制、治疗方法等内容进行了探讨。同时,对中医治疗勃起功能障碍的相关文献进行了复习,为临床治疗勃起功能障碍疾病提供参考依据。     

Myocardial infarction and its influence on male sexual function

Sexual dysfunction was studied in 50 patients who had had a myocardial infarction (MI) matched with 50 control patients who were comparable in terms of age, hypertension, diabetes, and smoking. The MI group revealed sexual dysfunction in 76%, with erectile dysfunction in 42%. In the control group there was sexual dysfunction in 68% and erectile dysfunction in 48%. There was no statistically significant difference observed between the two groups. However, there was a significant influence of sex counseling on subsequent sexual functioning. Patients who received information as to when it was safe for them to resume sexual activity showed a lesser degree of apprehension in the post-MI period. The need of sexual rehabilitation for these patients and more thorough epidemiological comparative studies are suggested.     

Trends in the Rate of Self-Report and Diagnosis of Erectile Dysfunction in the United States 1990–1998

Objective

To present the pattern of self-report and diagnosis of erectile dysfunction in the US over the time period 1990 through 1998 and examine whether the introduction of sildenafil in March 1998 influenced these findings.

Study design and methods

Retrospective database analysis. Data from the National Ambulatory Medical Care Survey (NAMCS) for the years 1990 through 1998 were used. Data from office-based physician-patient encounters for which either a complaint of erectile dysfunction as one of the reasons for requesting an encounter [National Center for Health Statistics (NCHS) code 1160.3] or a diagnosis of erectile dysfunction [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 302.72 or 607.84] was documented were extracted for men aged ≥40 years. National estimates per year were derived for: (i) the number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an encounter and the number of office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented; (ii) the rate per 1000 office-based physician-patient encounters for which a complaint of erectile dysfunction as a reason for requesting the encounter was documented and the rate per 1000 office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented; and (iii) the rate per 1000 US male population aged ≥40 years with a complaint of erectile dysfunction as a reason for requesting an encounter and the rate per 1000 US male population aged ≥40 years with a diagnosis of erectile dysfunction.

Results

The number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented increased from 764 682 in 1990 to 1 273 730 in 1998. The number of office-based physician-patient encounters with a recorded diagnosis of erectile dysfunction more than doubled over the time period examined, from 647 418 in 1990 to 1 495 793 in 1998. Office-based encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an appointment increased from 5.7 per 1000 in 1990 to 7.0 per 1000 in 1998; the rate of diagnosis of erectile dysfunction increased from 4.8 per 1000 in 1990 to 8.2 per 1000 in 1998. The population-adjusted rate of complaint of erectile dysfunction increased from 17.5 per 1000 in 1990 to 24.2 per 1000 in 1998; the rate of diagnosis increased from 14.9 per 1000 in 1990 to 28.4 per 1000 in 1998. In 1998, 2 142 776 office-based physician-patient encounters documented the prescribing of sildenafil; of these, 41% were for patients with a recorded diagnosis of erectile dysfunction.

Conclusions

The introduction of sildenafil was found not to have influenced the established upward trend in the documented rate of self-report of erectile dysfunction or the diagnosis of erectile dysfunction. However, the prescribing of sildenafil appears to offer greater insight into the actual magnitude of the problem erectile dysfunction represents in the US. Findings suggest there is a reluctance on the part of patients to discuss concerns about erectile dysfunction with their physician and a reluctance on the part of physicians to document patients’ expressed concerns regarding erectile dysfunction and/or to record a diagnosis of erectile dysfunction.

     

Effects du sildénafil sur la fonction/dysfonction endothéliale

Endothelial dysfunction is the main mechanism of cardio-vascular diseases, and can be non-invasively evaluated by the assessment of the flow-mediated vasodilatation in the brachial arterial using ultrasonography. Flow-mediated vasodilatation is decreased in patients with congestive heart failure but can be enhanced with sildenafil treatment. Flow-mediated vasodilatation is also enhanced with sildenafil treatment in patients with type 2 diabetes. In rats, chronic sildenafil might improve endothelium-dependent cavernosal relaxations and erectile function when altered.     

Management of sexual disorders in spinal cord injured patients

Spinal cord injured (SCI) patients have sexual disorders including erectile dysfunction (ED), impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I) such as Sildenafil (Viagra), intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM). Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy can be used to obtain sperm which can then be used for intra-uterine or in-vitro fertilization. Infertility treatment in male SCI patients involves a combination of the above treatments for erectile and anejaculatory dysfunctions. The basic approach to and management of sexual dysfunction in female SCI patients are similar as for men but do not require treatment for erectile or ejaculatory problems.     

Syndrome métabolique et dysfonctions sexuelles

The metabolic syndrome is closely associated to erectile dysfunction. In addition, an erectile dysfunction might reveal a metabolic syndrome. The metabolic syndrome is frequently associated to androgen deficiency and seems to be associated to female sexual dysfunction. The main target of the treatment is the insulin resistance. Physical activity and lost of weight are essential to reduce its incidence. In addition, testosterone and type 5 phosphodiesterase inhibitors can be used for the treatment of hypogonadism, and erectile dysfunction, respectively.     

Sexual dysfunction in male diabetics and alcoholics: A comparative study

Sexual dysfunction was evaluated in three groups of males 30–45 years of age: 52 diabetics, 48 alcoholics, and 30 men from a general practice. Diabetics and alcoholics showed the same incidence and symptom-pattern of sexual dysfunction, both groups differed significantly from the controls in symptom-patterns and in incidence of sexual dysfunction. This difference consisted of a higher rate of erectile dysfunction and reduced libido. Premature ejaculation was the most common symptom in the control group. Sexual dysfunction was uncorrelated to duration of diabetes and alcohol addiction. Diabetic sexual dysfunction was over-represented among patients having peripheral neuropathy, although 52 percent of diabetics reporting sexual dysfunction were without signs of neuropathy. The results may be explained partly by neurological damage as well as by problems concerning life quality of chronically ill patients. We suggest a more active communication about life style including the sexual sub-aspects. This communication should be based on a better knowledge from more stringent studies of relationships of sexual dysfunction and somatic disease.Editor's Note: Soren Buus Jensen has initiated a series of research studies on the sexual effects of diabetes. The article that follows is the first in a series of articles which will appear in the journal over the next year. These articles address the results of Dr. Jensen's work and will serve to broaden our knowledge of the sexual difficulties of the persons who have diabetes. As a reader, you can look forward to future articles on the younger diabetic male, diabetic females, and follow-up studies.     

Self-monitoring and self-focus in erectile dysfunction

Self-focused attention can cause anxiety and poor performance in those with low self-efficacy expectations. Self-monitoring is frequently used in sex therapy assessment. If self-monitoring is conceptualized as a self-focusing manipulation, it would be expected to cause "spectatoring," anxiety and deterioration in individuals with erectile dysfunction. Therefore, this investigation explored the relationship between the dispositional tendency to focus attention on the self (self-consciousness) and sexual behavior in males with erectile dysfunction, and evaluated the effects of self-monitoring on erectile dysfunctional males who differed in dispositional self-consciousness. Results indicate that (a) individuals with erectile dysfunction were less dispositionally self-conscious than nondysfunctional individuals, (b) self-monitoring had no adverse effects on any aspect of sexuality investigated, and (c) manipulated and dispositional self-focus had no interactive effects. Implications of these results for sex therapy and for a better understanding of etiological and maintaining factors in sexual dysfunction are discussed.     

Group treatment of single males with erectile dysfunction

Nine men with chronic erectile dysfunction (three primary, six secondary) who had no regular sexual partner were treated in two 12-session all-male psychoeducational therapy groups. Treatment interventions addressed specific factors which inhibited adequate sexual function with a focus on coping skills to overcome those factors. Pre, post, and follow-up behavioral self-report data and responses on a goal attainment scale questionnaire indicated that the treatment groups were successful for five men with secondary and one man with primary erectile dysfunction. Subjective report and pre- and posttreatment fantasy productions to TAT cards for the first group indicated that all men significantly improved their attitudes about sexuality and their sexual self-concept. The results suggest that this is a viable, cost-effective treatment for secondary erectile dysfunction, but not for primary erectile dysfunction unless supplementary individual therapy is provided.A version of this article was presented at the American Psychological Association annual meeting, San Francisco, September 1977.     

Correlation Between Angiotensin Converting Enzyme I/D Polymorphism and Erectile Dysfunction: An Appraisal

Angiotensin converting enzyme (ACE) is the major regulator of mineralocorticoid synthesis. ACE is mentioned for its responsibility for several vascular diseases. Considering the close relationship in the pathophysiology of these diseases and erectile dysfunction, the analysis of the association of genotypes in erectile dysfunction stands to reason. Here, the author performs a summative analysis on the recent previous reports on the ACE polymorphism and its correlation to erectile dysfunction. The meta-analysis was performed in order to assess the correlation between the pattern of ACE polymorphism and its correlation to erectile dysfunction. From available three case-control studies, 408 patients and 365 controls are evaluated. The overall frequencies of DD genotype for the patients and controls 28.2 are 21.6%, respectively. The overall frequency in the patients is slightly non-significant, higher ( 1.3 times) than controls (p >0.05). According to this study, 59.3% of subjects with DD genotype have erectile dysfunction while 50.6% of subjects without DD genotype have cardiovascular disease. From overall risk estimation, the subjects with DD genotype have 1.2 times higher risk to have erectile dysfunction.     

慢性前列腺炎患者心理状况与阴茎勃起功能的相关性

目的研究慢性前列腺炎患者心理状况与阴茎勃起功能的相关性。方法选取2013年6月至2016年6月达州市妇幼保健计划生育服务中心收治的120例慢性前列腺炎患者为研究对象,根据美国国立卫生研究院慢性前列腺炎症状指数评分表将患者分为轻度组(18例)、中度组(72例)、重度组(30例)。并选取同期来我院进行健康检查的120名男性健康志愿者作为对照组。比较不同程度慢性前列腺炎患者的阴茎勃起功能障碍程度、焦虑和抑郁水平。结果慢性前列腺炎程度越重,患者阴茎勃起功能障碍越重,焦虑和抑郁水平越重。合并阴茎勃起功能障碍的慢性前列腺炎患者的焦虑自评量表、抑郁自评量表和阴茎勃起功能障碍评分显著高于未合并阴茎勃起功能障碍的慢性前列腺炎患者,差异有统计学意义(P0.05)。结论慢性前列腺炎患者病情越重阴茎勃起功能障碍越重。慢性前列腺炎患者的焦虑和抑郁情绪可能会导致患者发生阴茎勃起功能障碍。