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 **;**:**–**.     

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.     

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.     

Interplay Between Premature Ejaculation and Erectile Dysfunction: A Systematic Review and Meta‐Analysis

IntroductionThe specific determinants and underlying factors linking erectile dysfunction (ED) and premature ejaculation (PE) have yet to be clearly identified.AimThe aim of this study was to review and meta‐analyze all available data regarding the link between ED and PE.MethodsAn extensive Medline Embase and Cochrane search was performed including the following words: “premature ejaculation” and “erectile dysfunction”.Main Outcome MeasuresAll observational trials comparing the risk of ED in relation to PE were included. Data extraction was performed independently by two of the authors (G.R, G.C.), and conflicts resolved by the third investigator (M.M.).ResultsOut of 474 retrieved articles, 18 were included in the study for a total of 57,229 patients, of which 12,144 (21.2%) had PE. The presence of PE, however defined, was associated with a significant increase in ED risk (odds ratio: 3.68[2.61;5.18]; P < 0.0001). Meta‐regression analysis showed that the risk of ED in PE subjects was higher in older individuals as well as in those with a lower level of education and in those who reported a stable relationship less frequently. In addition, subjects with PE and ED more often reported anxiety and depressive symptoms and a lower prevalence of organic associated morbidities, including diabetes mellitus, hypertension and dyslipidemia. All the latter associations were confirmed even after adjustment for age. Finally the risk of PE‐related ED increased with the increased proportion of acquired ejaculatory problems (adj r = 0.414; P < 0.0001 after the adjustment for age).ConclusionsIn conclusion, the present data showed that ED and PE are not distinctly separate entities, but should be considered from a dimensional point of view. Understanding this dimensional perspective might help sexual health care professionals in providing the most appropriate therapeutic approach to realistically increase patient related outcomes in sexual medicine. Corona G, Rastrelli G, Limoncin E, Sforza A, Jannini EA, and Maggi M. The interplay between premature ejaculation and erectile dysfunction: A systematic review and meta‐analysis. J Sex Med 2015;12:2291–2300.     

Tadalafil Once Daily Improves Ejaculatory Function,Erectile Function,and Sexual Satisfaction in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia and Erectile Dysfunction: Results from a Randomized,Placebo‐ and Tamsulosin-Controlled, 12-Week Double-Blind Study

IntroductionTadalafil, a long‐acting phosphodiesterase type 5 inhibitor, is approved for treating signs and symptoms of benign prostatic hyperplasia (BPH) and erectile dysfunction (ED); tamsulosin, an alpha‐blocker, is approved for treating signs and symptoms of BPH.AimTo determine the effects of tadalafil or tamsulosin on sexual function, including ejaculation and orgasm, satisfaction, and erectile function, in sexually active men with ED and lower urinary tract symptoms suggestive of BPH (LUTS/BPH).MethodsA randomized, double‐blind, placebo‐controlled study of tadalafil 5 mg once daily for 12 weeks in men with LUTS/BPH; tamsulosin 0.4 mg once daily was an active control.Main Outcome MeasuresThe International Index of Erectile Function (IIEF) questionnaire was administered at baseline and 4, 8, and 12 weeks. Analysis of orgasm and ejaculation was post hoc based on the IIEF‐Orgasmic Function (OF) domain (IIEF‐Q9 [ejaculatory frequency] and Q10 [orgasmic frequency]). Other measures included IIEF‐Intercourse Satisfaction (IS), Overall Satisfaction (OS), and Erectile Function (EF) domains. Changes from baseline to 12 weeks (or last observation) vs. placebo were analyzed using analysis of covariance. Higher IIEF scores indicate better functioning.ResultsOf 511 study participants, 310 (60.7%) had ED and were sexually active. The IIEF‐OF increased significantly through 12 weeks with tadalafil vs. placebo (P = 0.048), as did IIEF‐Q9 (P = 0.045) but not IIEF‐Q10 (P = 0.100). Compared with placebo, IIEF‐OF, Q9, and Q10 decreased significantly with tamsulosin (all P < 0.05). The IIEF‐IS and OS increased significantly at end point with tadalafil (both P < 0.001); for tamsulosin, change was not significant for IS, while OS decreased significantly (P = 0.009). The IIEF‐EF domain increased significantly vs. placebo with tadalafil (P < 0.001) but not tamsulosin (P = 0.699).ConclusionsTadalafil 5 mg once daily significantly improved ejaculation and orgasm, intercourse and overall satisfaction, and erectile function. Men receiving tamsulosin 0.4 mg once daily experienced a decrease in both ejaculatory/orgasmic frequency and overall satisfaction vs. placebo, with no significant effect on erectile function.     

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 **;**:**–**.     

Factors Associated with Sex Hormones and Erectile Dysfunction in Male Taiwanese Participants with Obesity

IntroductionObesity has been receiving an increasing amount of attention recently, but investigations regarding the potential impact of obesity, sexual behaviors, and sex hormones on erectile dysfunction (ED) in men have not completely clarified the association.AimTo identify the relationship between ED, sexual behavior, sexual satisfaction, sex hormones, and obesity in older adult males in Taiwan.MethodsData were obtained from a baseline survey of 476 older adult males (≧40 years old). Their demographic data, body mass index (BMI), sex hormones, sexual desire, sexual satisfaction, and ED status were assessed.Main Outcome MeasuresThe International Index of Erectile Function-5 (IIEF-5), Sexual Desire Inventory (SDI), and Sexual Satisfaction Scale (SSS) were used to assess ED, sexual desire, and sexual satisfaction.ResultsIn all, 476 men were available for analysis. The mean age of the sample was 51.34 ± 7.84 years (range 40 to 70 years). The IIEF total score had a mean of 19.44 ± 4.98; 264 (55.5%) subjects had ED, 250 (52.9%) were currently obese (BMI ≧27), and 297 (62.4%) had metabolic syndrome. The results showed an increased risk of ED among obese men and subjects with lower levels of sex hormones and lower sexual desire. Testosterone levels were lower in subjects with obesity (P < 0.001). Among the predictors of ED, obesity (odds ratio [OR] = 1.62, 95% CI = 1.07–2.44, P = 0.021), abnormal high sensitivity C-reactive protein (hs-CRP) (OR = 10.59, 95% CI = 4.70–23.87, P < 0.001), and lower serum full testosterone (OR = 3.27, 95% CI = 2.16–4.93, P < 0.001) were significantly independent factors.ConclusionsThis study supports the idea of a close relationship between low levels of sex hormones, sexual desire, sexual satisfaction, obesity, and ED, and also shows that low free testosterone and hs-CRP may predict ED, even in obese populations. Shi M-D, Chao J-K, Ma M-C, Hao L-J, and Chao I-C. Factors associated with sex hormones and erectile dysfunction in male Taiwanese participants with obesity. J Sex Med 2014;11:230–239.     

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.     

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.     

Interrelationships among measures of premature ejaculation: the central role of perceived control

IntroductionDomains of premature ejaculation (PE) include short intravaginal ejaculatory latency time (IELT), poor perceived control over ejaculation, decreased satisfaction with sexual intercourse, and personal distress and interpersonal difficulty related to ejaculation. How these measures interrelate is unknown.AimHere, we evaluated the interrelationships between these PE-specific variables, applying cross-sectional data from a large U.S. observational study of men with PE.MethodsWe analyzed data from men with PE identified in a previously reported observational study. PE was diagnosed by experienced clinicians using the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision.Main Outcome MeasuresSubjects reported their stopwatch-measured IELT, perceived control over ejaculation, satisfaction with sexual intercourse, personal distress related to ejaculation, and interpersonal difficulty related to ejaculation. Relationships between variables were assessed using bivariate correlations, and the strength and significance of direct or indirect effects between variables were evaluated using a form of regression analysis known as path analysis.ResultsBivariate Pearson correlation coefficients for all relationships were significant at the P ≤ 0.05 level, with the exception of IELT and interpersonal difficulty related to ejaculation. When all variables were included in the model, IELT showed a significant direct effect on perceived control over ejaculation but did not show a significant direct effect on ejaculation-related personal distress or satisfaction with sexual intercourse. Perceived control over ejaculation showed a significant direct effect on both ejaculation-related personal distress and satisfaction with sexual intercourse, which each showed direct effects on interpersonal difficulty related to ejaculation.ConclusionsThe patient's perception of control over ejaculation is central to understanding how PE is associated with satisfaction with sexual intercourse and ejaculation-related distress. In contrast, the association of IELT with satisfaction with sexual intercourse and distress related to ejaculation is mediated by perceived control over ejaculation. Patrick DL, Rowland D, and Rothman M. Interrelationships among measures of premature ejaculation: The central role of perceived control.     

ORIGINAL RESEARCH—EJACULATORY DISORDERS: Screening for Erectile Dysfunction in Men with Lifelong Premature Ejaculation—Is the Sexual Health Inventory for Men (SHIM) Reliable?

IntroductionSome men with premature ejaculation (PE) and normal erectile function record contradictory response/s to The Sexual Health Inventory for Men (SHIM) and may be incorrectly categorized as suffering from erectile dysfunction (ED).AimsThe aim of this study was to evaluate the frequency of false positive SHIM diagnosis of ED in men with lifelong PE.Main Outcome MeasuresSHIM, stopwatch intravaginal ejaculation latency time (IELT).MethodsA prospective observational study of men with normal erectile function and lifelong PE, diagnosed using the ISSM definition of lifelong PE, was conducted. The SHIM was self-administered at Visit 1. Mean per subject stopwatch IELT was determined from four subsequent intercourse attempts.ResultsSeventy-eight subjects with a mean age of 33.2 ± 8.3 years and a geometric mean IELT of 15.9 ± 2.3 seconds were enrolled. The mean SHIM score for all subjects was 20.4 ± 6.0. Fifty-two subjects (66.7%) have SHIM scores of >21 (mean 24.3 ± 1.1), consistent with normal erectile function, and a geometric mean IELT of 18.3 ± 2.2 seconds. Twenty-six subjects (33.3%) had SHIM scores <22 (mean 12.7 ± 3.7), consistent with a false positive diagnosis of ED, and a geometric mean IELT of 10.5 ± 2.3 seconds. The incidence of false positive SHIM diagnosis of ED (SHIM < 22) was inversely related to the IELT. Although the geometric mean IELT for subjects with SHIM scores <22 was significantly less than that of all subjects and subjects with SHIM scores >21, there were no significant differences between the geometric mean IELT or the IELT distribution of all subjects vs. the normal erectile function IELT (SHIM > 21) cohort.ConclusionThis study demonstrates a 33.3% false positive SHIM diagnosis of ED in men with PE. This is likely to limit subject recruitment in clinical trials by exclusion of subjects with low-range IELTs but is unlikely to result in significantly different baseline IELTs or IELT distributions. McMahon CG. Screening for erectile dysfunction in men with lifelong premature ejaculation—Is the Sexual Health Inventory for Men (SHIM) reliable? J Sex Med 2009;6:567–573.     

Prevalence and Factors Associated with the Complaint of Premature Ejaculation and the Four Premature Ejaculation Syndromes: A Large Observational Study in China

IntroductionAlthough the new classification of premature ejaculation (PE) has been proposed by Waldinger et al., there have been few studies investigating the four PE syndromes in China.AimsWe investigated the prevalence and factors associated with the complaint of PE and the four PE syndromes in Anhui province, China.MethodsBetween September 2011 and September 2012, subjects were selected from five cities in Anhui province, China. They participated in this survey by completing a detailed verbal questionnaire regarding their demographic data and medical and sexual history. Men with PE complaint were diagnosed as lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), or premature‐like ejaculatory dysfunction (PLED).Main Outcome MeasuresPE complaint was divided into four PE syndromes. Anxiety, depression, and erectile dysfunction were independently assessed by the self‐rating anxiety/depression scale and the international index of erectile function‐5, respectively.ResultsOf the 3,016 men evaluated, 25.80% complained of PE. The distribution of the four PE syndromes in men with PE complaint was in the order of NVPE (44.09%), PLPE (24.81%), APE (18.77%), and LPE (12.34%). Patients with PE complaint were older and more likely to smoke, had more comorbidities, and a higher body mass index (BMI) than patients without the complaint (P < 0.001 for all). Similar findings were also observed in patients with APE compared with other PE patients (depression P = 0.012, cardiovascular P = 0.003, others P < 0.001). In addition, the rates of counseling by a doctor in men with LPE and APE were higher than those in men with NVPE and PLED (P < 0.001).ConclusionThe prevalence of PE complaint in male population of Anhui province, China, was 25.80%, with the highest PE syndromes being NVPE and PLPE. Patients with PE complaint or APE were older and more likely to smoke, had more comorbidities, and a higher BMI. Gao J, Zhang X, Su P, Liu J, Xia L, Yang J, Shi K, Tang D, Hao Z, Zhou J, and Liang C. Prevalence and factors associated with the complaint of premature ejaculation and the four premature ejaculation syndromes: a large observational study in China. J Sex Med 2013;10:1874–1881.     

Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?

IntroductionRecent epidemiological studies reported high prevalence rates of erectile dysfunction (ED) among younger heterosexual men (≤40). It has been suggested that this “epidemic” of ED is related to increased pornography use. However, empirical evidence for such association is currently lacking.AimThis study analyzes associations between pornography use and sexual health disturbances among younger heterosexual men using four large-scale online samples from three European countries.MethodsThe analyses were carried out using a 2011 cross-sectional online study of Croatian, Norwegian, and Portuguese men (Study 1; N = 2,737) and a 2014 cross-sectional online study of Croatian men (Study 2; N = 1,211). Chi-square test and multivariate logistic regression were used to explore the associations between pornography use and sexual difficulties.Main Outcome MeasuresIn Study 1, erectile difficulties, inability to reach orgasm, and a lack of sexual desire were measured using the Global Study of Sexual Attitudes and Behavior indicators. In Study 2, ED was measured with the abridged International Index of Erectile Function (IIEF-5). Delayed ejaculation and a decrease of sexual desire were assessed with one-item indicators.ResultsIn Study 1, only the relationship between pornography use and ED among Croatian men was statistically significant (χ²[2] = 18.76, P < 0.01). The association was small and inconsistent. Compared with infrequent use of pornography, moderate but not high frequency of pornography use increased the odds of reporting ED (adjusted odds ratio = 0.53, P < 0.01). In Study 2, no significant associations both between either the frequency or the recent dynamics of pornography use and male sexual dysfunctions were observed.ConclusionWe found little evidence of the association between pornography use and male sexual health disturbances. Contrary to raising public concerns, pornography does not seem to be a significant risk factor for younger men's desire, erectile, or orgasmic difficulties. Landripet I and Štulhofer A. Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men? J Sex Med 2015;12:1136–1139.     

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.     

Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages?

IntroductionThe impact of erectile dysfunction (ED) on patients’ sexual satisfaction and mood profile could differ across different ages.AimTo investigate the relationship between erectile function (EF), sexual satisfaction, and mood status among patients seeking medical help for ED.MethodsData from 765 patients presenting at a single center for ED were analyzed. Patients were categorized as young (≤50 years), middle-aged (>50 and ≤65 years), and old (>65 years) individuals and completed the International Index of Erectile Function (IIEF) and the Beck’s Inventory for Depression (BDI).Main Outcome MeasuresThe IIEF overall satisfaction and intercourse satisfaction domain scores and the BDI score were used to investigate sexual life satisfaction and depressive symptoms (defined as BDI > 11) across ages and according to ED severity. Linear and logistic regression analyses assessed the relationship between satisfaction scores and the risk of depressive symptoms with age and EF.ResultsMedian (interquartile range) age at first assessment for ED was 50 (38, 59) years. Compared with older men, young and middle-aged patients showed significantly higher IIEF-OS and IIEF– Intercourse Satisfaction scores for increasing IIEF-EF scores. Older men showed no difference in terms of satisfaction scores for mild ED and normal EF status. At linear regression analysis, both IIEF-EF and age were significantly associated with sexual satisfaction (all P < .0001). The interaction term between age and EF was also significant, suggesting that the older the patients, the higher the feeling of sexual satisfaction for the same EF status (P = .004). Overall, 25% of patients reported depressive symptoms. Logistic regression analysis showed a 40% risk of depressive symptoms for patients <45 years with severe ED compared to a risk <20% for a man >65 years of age with the same EF status.Clinical ImplicationsTreating older patients with mild ED may not lead to a further improvement in sexual satisfaction as compared with younger patients with the same ED severity. Younger ED patients suffer more from depressive symptoms compared with older men, regardless of ED severity, thus supporting the need for a comprehensive psychological counseling.Strength & LimitationsThe single-center design and the lack of the assessment of the impact of ED treatment are the main limits.ConclusionsThe clinical management of ED should be tailored according to different ages: younger patients deserve to be investigated and eventually treated for depressive symptoms. Older patients should be counseled for treatment when a sexual satisfaction improvement is expected.Capogrosso P, Ventimiglia E, Boeri L, et al. Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages? J Sex Med 2019;16:999–1004.     

Long‐Term Changes of Sexual Function in Men with Obstructive Sleep Apnea after Initiation of Continuous Positive Airway Pressure

IntroductionObstructive sleep apnea (OSA), particularly intermittent nocturnal hypoxemia, is associated with erectile dysfunction (ED).AimWe investigated in patients with OSA whether continuous positive airway pressure (CPAP) therapy has a long‐term effect on sexual function, including ED, in the presence of other risk factors for ED.MethodsWithin a long‐term observational design, we reassessed 401 male patients who had been referred for polysomnography, with respect to erectile and overall sexual function. Mean ± standard deviation follow‐up time was 36.5 ± 3.7 months. Patients with moderate to severe ED were stratified according to the regular use of CPAP.Main Outcome MeasureChanges of sexual function were assessed by the 15‐item International Index of Erectile Function (IIEF‐15) questionnaire, including the domains erectile function (EF), intercourse satisfaction, orgasmic function (OF), sexual desire (SD), and overall satisfaction (OS).ResultsOf the 401 patients, 91 returned a valid IIEF‐15 questionnaire at follow‐up. Their baseline characteristics were not different from those of the total study group. OSA (apnea–hypopnea index >5/hour) had been diagnosed in 91.2% of patients. In patients with moderate to severe ED (EF domain <17), CPAP users (N = 21) experienced an improvement in overall sexual function (IIEF‐15 summary score; P = 0.014) compared with CPAP non‐users (N = 18), as well as in the subdomains OF (P = 0.012), SD (P = 0.007), and OS (P = 0.033). Similar results were obtained in patients with poor overall sexual dysfunction (IIEF‐15 summary score <44). In patients with moderate to severe ED and low mean nocturnal oxygen saturation (≤93%, median), also the EF subdomain improved in CPAP users vs. non‐users (P = 0.047).ConclusionsThese data indicate that long‐term CPAP treatment of OSA and the related intermittent hypoxia can improve or preserve sexual function in men with OSA and moderate to severe erectile or sexual dysfunction, suggesting a certain reversibility of OSA‐induced sexual dysfunctions. Budweiser S, Luigart R, Jörres RA, Kollert F, Kleemann Y, Wieland WF, Pfeifer M, and Arzt M. Long‐term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure. J Sex Med **;**:**–**.     

ORIGINAL RESEARCH–ENDOCRINOLOGY: Hypoprolactinemia: A New Clinical Syndrome in Patients with Sexual Dysfunction

IntroductionThe physiological role of prolactin (PRL) in male sexual behavior is poorly understood. Conversely, the association between PRL pathological elevation in both reproductive and sexual behavior is well defined.AimThe aim of the present study is to assess the correlates of normal PRL (PRL < 735 mU/L or 35 ng/mL), in male subjects consulting for sexual dysfunction.MethodsA consecutive series of 2,531 (mean age 52.0 ± 12.9 years) subjects was investigated. Patients were interviewed using the structured interview on erectile dysfunction (SIEDY), a 13-item tool for the assessment of erectile dysfunction (ED)-related morbidities. Middlesex Hospital Questionnaire was used for the evaluation of psychological symptoms.Main Outcome MeasuresSeveral hormonal (testosterone, thyroid stimulation hormone, and PRL) and biochemical parameters (glycemia and lipid profile) were studied, along with penile Doppler ultrasound (PDU) and SIEDY items.ResultsAfter adjustment for confounders anxiety symptoms decreased across PRL quartiles (I: <113 mU/L or 5 ng/mL; II: 113–156 mU/L or 5.1–7 ng/mL; III: 157–229 mU/L or 7.1–11 ng/mL; IV: 229–734 mU/L or 11.1–34.9 ng/mL). Patients in the lowest PRL quartile showed a higher risk of metabolic syndrome (MetS; odds ratio [OR] = 1.74 [1.01–2.99], P < 0.05), arteriogenic ED (peak systolic velocity at PDU < 35 cm/sec; OR = 1.43 [1.01–2.03], P < 0.05), and premature ejaculation (PE; OR = 1.38 [1.02–1.85]; P < 0.05). Conversely, comparing subjects with PRL-secreting pituitary adenomas (N = 13) with matched controls, no significant difference was observed, except for a higher prevalence of hypoactive sexual desire in hyperprolactinemia.ConclusionsOur findings demonstrate that, in subjects consulting for sexual dysfunction, PRL in the lowest quartile levels are associated with MetS and arteriogenic ED, as well as with PE and anxiety symptoms. Further studies are advisable in order to confirm our preliminary results in different populations. Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, Boddi V, Bandini E, Balercia G, Forti G, and Maggi M. Hypoprolactinemia: A new clinical syndrome in patients with sexual dysfunction. J Sex Med 2009;6:1457–1466.     

A Survey of Erectile Dysfunction in Taiwan: Use of the Erection Hardness Score and Quality of Erection Questionnaire

IntroductionThere are currently no studies in the Asia-Pacific region using the erection hardness score (EHS) and Quality of Erection Questionnaire (QEQ) to assess erectile dysfunction (ED).AimsTo provide up-to-date data on the prevalence of ED in Taiwanese men and to validate the EHS and QEQ in this population.MethodsA representative sample of 1,060 men aged ≥30 years completed a telephone interview. ED status was confirmed via direct questioning and using the abridged five-item version of the 15-item International Index of Erectile Function (IIEF-5). Responses regarding EHS, QEQ, marital and sexual satisfaction, and attitude to treatment were also recorded.Main Outcome MeasuresIIEF, EHS, and QEQ.ResultsThe prevalence of ED, as defined by IIEF-5, was 27% among all respondents and 29% among those aged ≥40 years. Although, the prevalence of ED increased with age, men of all ages tended to underestimate their erectile problems. Among men who indicated that they did not have ED, 25% were found to have mild to moderate ED according to the IIEF-5 assessment. An EHS ≤3, indicating the presence of ED, was reported in 26% of men. The EHS was consistent with the QEQ: When the EHS was 4, the satisfaction of each domain of QEQ ranged from 85% to 90%. The QEQ score correlated well with the IIEF-5 score and significantly affected both sexual and marital satisfaction (P < 0.005).ConclusionsThese data indicate that EHS is a simple, practical tool for clinical use. QEQ scores appear to be independently associated with sexual and marital satisfaction, and may be of value in the assessment and monitoring of ED patients. While ED is a common health problem in Taiwan and the prevalence of ED increases with age, affected men lack awareness regarding the presence of erectile problems and the importance of initiating timely and effective treatment. Hwang TIS, Tsai T-F, Lin Y-C, Chiang H-S, and Chang LS. A survey of erectile dysfunction in Taiwan: Use of the erection hardness score and quality of erection questionnaire.     

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.