Association of oxidative stress with erectile dysfunction in community-dwelling men and men on dialysis

OBJECTIVES

To investigate the association between oxidative stress and erectile dysfunction (ED) in community-dwelling men and men on dialysis.

METHODS

This cross-sectional study included 398 community-dwelling men and 42 men on dialysis. Oxidative stress was assessed using 8-hydroxy-2'-deoxyguanosine (8-OHdG). Univariable and multivariable logistic regression analyses were performed to evaluate the association between oxidative stress and ED.

RESULTS

Spearman's rank correlation test showed no significant correlation between urine 8-OHdG levels and the 5-Item International Index of Erectile Function scores in community-dwelling men (ρ = -0.005, p = 0.917) and between plasma 8-OHdG levels and the Sexual Health Inventory for Men scores in men on dialysis (ρ = 0.166, p = 0.295). In community-dwelling men, univariable and multivariable analyses revealed that urine 8-OHdG level was not significantly associated with ED (odds ratio [OR]: 1.005, 95% confidence interval [CI]: 0.884-1.144, p = 0.934; OR: 0.930, 95% CI: 0.798-1.084, p = 0.353; respectively). In men on dialysis, univariable analyses revealed that plasma 8-OHdG level was not significantly associated with severe ED (OR: 0.967, 95% CI: 0.876-1.066, p = 0.498).

CONCLUSIONS

Oxidative stress was not significantly associated with ED prevalence and severity in community-dwelling men and men on dialysis.

Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy

BACKGROUND

Prior studies suggest that men with good erectile function shortly after radical prostatectomy (RP) can subsequently have worsened erectile function.

AIM

To determine the prevalence and predictors of early erectile function recovery post-RP and of worsening erectile function after initial erectile function recovery.

METHODS

We retrospectively queried our institutional database. Men who underwent RP during 2008-2017 and who completed the International Index of Erectile Function erectile function domain both pre-RP and serially post-RP, constituted the population. Functional erections were defined as International Index of Erectile Function (IIEF)-6 erectile function domain scores ≥24. We analyzed factors predicting functional erections at 3 months post-RP as well as factors predicting a decrease in functional erections between 3 and 6 months, defined as ≥2-point drop in the erectile function domain. Multivariable logistic regression models were used to identify predictors of early erectile function recovery and also of subsequent decline.

OUTCOMES

Erectile function recovery rates at 3 months post-RP and predictive factors; rates of erectile function decline between 3-6 months and associated predictors.

RESULTS

Eligible patients comprised 1,655 men with median age of 62 (IQR 57, 67) years. Bilateral nerve-sparing (NS) surgery was performed in 71% of men, unilateral NS in 19%, and no NS in 10%. Of this population, 224 men (14%; 95% CI 12%, 15%) had functional erections at 3 months post-RP. On multivariable analysis, significant predictors of early erectile function recovery included: younger age (OR 0.93, P < .001), higher baseline erectile function domain score (OR 1.14, P < .001) and bilateral NS (OR 3.81, P = .002). The presence of diabetes (OR 0.43, P = .028) and a former smoking history (OR 0.63, P = .008; reference group: never smoker) was associated with the erectile dysfunction at 3 months post-RP. Of the men with early functional erections, 41% (95% CI 33%, 48%) had a ≥ 2-point decline in erectile function between 3 and 6 months. No factors were identified as predictors for this decline.

CLINICAL IMPLICATIONS

Only a small proportion of men have functional erections at 3 months post-RP and a notable number of them will experience a decline in erectile function between 3 and 6 months.

STRENGTHS AND LIMITATIONS

Strengths: large patient population and the use of validated questionnaire.

LIMITATIONS

single-center retrospective study.

CONCLUSION

A minority of men had functional erections 3 months post-RP, about half of whom had a decline in erectile function by month 6. We recommend appropriately counseling post-RP patients on the risk of such a decline in erectile function. Salter CA, Tin AL, Bernie HL, et al. Predictors of Worsening Erectile Function in Men with Functional Erections Early After Radical Prostatectomy. J Sex Med 2022;19:1790-1796.

Impact of COVID 19 on erectile function

Purpose: COVID-19, a novel infection, presented with several complications, including socioeconomical and reproductive health challenges such as erectile dysfunction (ED). The present review summarizes the available shreds of evidence on the impact of COVID-19 on ED.Materials and methods: All published peer-reviewed articles from the onset of the COVID-19 outbreak to date, relating to ED, were reviewed. Results: Available pieces of evidence that ED is a consequence of COVID-19 are convincing. COVID-19 and ED share common risk factors such as disruption of vascular integrity, cardiovascular disease (CVD), cytokine storm, diabetes, obesity, and chronic kidney disease (CKD). COVID-19 also induces impaired pulmonary haemodynamics, increased ang II, testicular damage and low serum testosterone, and reduced arginine-dependent NO bioavailability that promotes reactive oxygen species (ROS) generation and endothelial dysfunction, resulting in ED. In addition, COVID-19 triggers psychological/mental stress and suppresses testosterone-dependent dopamine concentration, which contributes to incident ED.Conclusions: In conclusion, COVID-19 exerts a detrimental effect on male reproductive function, including erectile function. This involves a cascade of events from multiple pathways. As the pandemic dwindles, identifying the long-term effects of COVID-19-induced ED, and proffering adequate and effective measures in militating against COVID-19-induced ED remains pertinent.

Prevalence of Poisoned Google Search Results of Erectile Dysfunction Medications Redirecting to Illegal Internet Pharmacies: Data Analysis Study

Background

Illegal online pharmacies function as affiliate networks, in which search engine results pages (SERPs) are poisoned by several links redirecting site visitors to unlicensed drug distribution pages upon clicking on the link of a legitimate, yet irrelevant domain. This unfair online marketing practice is commonly referred to as search redirection attack, a most frequently used technique in the online illegal pharmaceutical marketplace.

Objective

This study is meant to describe the mechanism of search redirection attacks in Google search results in relation to erectile dysfunction medications in European countries and also to determine the local and global scales of this problem.

Methods

The search engine query results regarding 4 erectile dysfunction medications were documented using Google. The search expressions were “active ingredient” and “buy” in the language of 12 European countries, including Hungary. The final destination website legitimacy was checked at LegitScript, and the estimated number of monthly unique visitors was obtained from SEMrush traffic analytics. Compromised links leading to international illegal medicinal product vendors via redirection were analyzed using Gephi graph visualization software.

Results

Compromised links redirecting to active online pharmacies were present in search query results of all evaluated countries. The prevalence was highest in Spain (62/160, 38.8%), Hungary (52/160, 32.5%), Italy (46/160, 28.8%), and France (37/160, 23.1%), whereas the lowest was in Finland (12/160, 7.5%), Croatia (10/160, 6.3%), and Bulgaria (2/160, 1.3%), as per data recorded in November 2020. A decrease in the number of compromised sites linking visitors to illegitimate medicine sellers was observed in the Hungarian data set between 2019 and 2021, from 41% (33/80) to 5% (4/80), respectively. Out of 1920 search results in the international sample, 380 (19.79%) search query results were compromised, with the majority (n=342, 90%) of links redirecting individuals to 73 international illegal medicinal product vendors. Most of these illegal online pharmacies (41/73, 56%) received only 1 or 2 compromised links, whereas the top 3 domains with the highest in-degree link value received more than one-third of all incoming links. Traffic analysis of 35 pharmacy specific domains, accessible via compromised links in search engine queries, showed a total of 473,118 unique visitors in November 2020.

Conclusions

Although the number of compromised links in SERPs has shown a decreasing tendency in Hungary, an analysis of the European search query data set points to the global significance of search engine poisoning. Our research illustrates that search engine poisoning is a constant threat, as illegitimate affiliate networks continue to flourish while uncoordinated interventions by authorities and individual stakeholders remain insufficient. Ultimately, without a dedicated and comprehensive effort on the part of search engine providers for effectively monitoring and moderating SERPs, they may never be entirely free of compromised links leading to illegal online pharmacy networks.

Erectile dysfunction and premature ejaculation: a continuum movens supporting couple sexual dysfunction

PURPOSE

The specific underlying mechanisms supporting the association between erectile dysfunction (ED) and premature ejaculation (PE) are still not completely clarified. To summarize and discuss all available data supporting the relationship between PE and ED.

METHODS

A comprehensive narrative review was performed. In addition, to better clarify the specific factors underlining ED and PE, a meta-analytic approach of the selected evidence was also performed. In particular, the meta-analytic method was selected in order to minimize possible sources of bias derived from a personal interpretation of the data.

RESULTS

Current data confirm the close association between ED and PE and the bidirectional nature of their relationship. In particular, PE was associated with a fourfold increased risk of ED independently of the definition used. In addition, the risk increased in older patients and in those with lower education, and it was associated with higher anxiety and depressive symptoms. Conversely, ED-related PE was characterized by lower associations with organic parameters such as diabetes mellitus, arterial hypertension, dyslipidemia and with smoking habit. Finally, when ED was defined according to the International Index of Erectile Function questionnaire, the presence of a stable relationship increased the risk.

CONCLUSIONS

ED and PE should be considered in a dimensional prospective way considering the possibility that both clinical entities can overlap and influence each. Correctly recognizing the underlying factors and sexual complaint can help the clinician in deciding the more appropriate diagnostic and therapeutic work-up.

Plant-based diet index and erectile dysfunction in the Health Professionals Follow-Up Study

OBJECTIVE

To evaluate the longitudinal association between plant-based diet index (PDI) score and incident erectile dysfunction (ED).

MATERIALS AND METHODS

We conducted a prospective analysis of 21 942 men aged 40 to 75 years who were enrolled in the Health Professionals Follow-Up Study. ED was assessed with questionnaires every 4 years starting in 2000. Dietary data were collected via validated food frequency questionnaires completed every 4 years and were used to calculate total PDI scores, as well as healthy (hPDI) and unhealthy (uPDI) subscores. Multivariable Cox proportional hazards models were used to compute hazard ratios (HRs) for incident ED. All models were stratified by age (<60, 60 to <70, ≥70 years).

RESULTS

Among men aged 60 to <70 years, hPDI was inversely associated with incident ED. Those in the highest quintile of hPDI in that age group had an 18% lower risk of ED (HR 0.82, 95% confidence interval (CI) 0.73-0.91; P-trend <0.001) compared to those in the lowest quintile. Conversely, uPDI was positively associated with ED in men aged <60 years (HR 1.27, 95% CI 1.01-1.60; P-trend = 0.02).

CONCLUSIONS

Encouraging a healthy plant-based diet may be an environmentally sustainable intervention for men interested in maintaining erectile function.

Association between blood glucose levels and autonomic symptoms in Peru

AIMS

To determine whether there is an association between high blood glucose levels and having autonomic symptoms among adults aged 30-69 years.

MATERIAL AND METHODS

A population-based cross-sectional study was conducted. The presence of autonomic symptoms was defined as the positive response to any item of the Survey of Autonomic Symptoms (SAS). Blood glucose levels were defined as euglycemia, prediabetes, and type 2 diabetes (T2D), based on oral glucose tolerance test. Poisson regression, with link log and robust variance, and linear regression were conducted to evaluate the association of interest.

RESULTS

A total of 1607 subjects, mean age 48.2 (SD: 10.6) and 810 (49.7 %) women, were included. T2D was associated with higher prevalence of erectile dysfunction (PR = 3.00; 95 % CI: 1.78-5.02) and dryness of mouth and eyes (PR = 1.29; 95 % CI: 1.02-1.61) compared with those with euglycemia. Those with T2D had 0.32 (95 % CI: 0.04-0.62) and 1.03 (95 % CI: 0.03-2.03) more points in the SAS score and severity scale, respectively.

CONCLUSIONS

Erectile dysfunction and dry mouth and eyes are the more common autonomic symptoms associated with T2D. Our results suggest a periodic evaluation of sexual function and eye humidity among T2D patients.

Associations between exposure to different heavy metals and self-reported erectile dysfunction: a population-based study using data from the 2001-2004 National Health and Nutrition Examination Survey

Heavy metals are ubiquitous and nonbiodegradable pollutants that are widely distributed in the environment. Heavy metal exposure can damage various biological tissues and cause several diseases. This study aimed to investigate the association between blood and urinary cadmium, lead, and mercury levels and erectile dysfunction (ED) based on data from the 2001-2004 National Health and Nutrition Examination Survey. In total, 3681 participants were included in the analysis. Results showed that participants with ED had high blood cadmium, mercury, creatinine, urinary lead, cadmium levels, low blood lead, serum cotinine, and urinary mercury levels. Multivariate logistic regression analysis showed that only blood cadmium level was an independent risk factor of ED (tertile [T]2 vs T1: odds ratio = 1.495, 95% confidence interval: 1.181-1.892, p = 0.001; T3 vs T1: odds ratio = 2.089, 95% confidence interval: 1.554-2.809, p < 0.001). The dose-response curve showed a positive nonlinear association between blood cadmium and lead levels and ED and a negative nonlinear association between blood and urinary mercury levels and ED after propensity score matching. In conclusion, heavy metal exposure is closely correlated with the development of ED, and a high blood cadmium level is an independent risk factor of ED.

Sexual dysfunction among men with diabetes; a cross-sectional study at a specialised diabetes clinic in Sri Lanka

BACKGROUND

Male sexual dysfunction in diabetes is often an unrevealed clinical issue. Though many publications report the prevalence, there is limited data on its associations, impact, and health-seeking behaviour. The objectives were to assess the prevalence of male sexual dysfunction, its associations, impact and treatment-seeking among men with diabetes in a selected tertiary care Diabetes Clinic.

METHODS

A cross-sectional study was conducted at the Diabetes Clinic, National Hospital of Sri Lanka, from January to September 2020. Men with diabetes aged 18 to 70 years undergoing annual assessment were recruited consecutively. Socio-demographic and clinical information were collected using an interviewer-administered questionnaire. Erectile dysfunction (ED), premature ejaculation, mental health and quality of life were assessed using validated self-administered questionnaires. Cardiovascular autonomic reflex tests and total testosterone levels were performed. Penile colour Doppler ultrasonography was performed on consenting participants with erectile dysfunction. Associations were assessed using the chi-square test or Fisher's exact for dichotomous variables and independent sample t-test for continuous variables.

RESULTS

Two hundred and twelve participants were recruited with a mean age of 54.1 (SD = 10.1) years. Erectile dysfunction was present in 168 (79.2%), (mild: 45, mild-moderate: 56, moderate: 26, severe: 41). Premature ejaculation was present in 26 (18.7%). Libido was low among 16%. Sexual dysfunction was not revealed to a health provider by 85.6% despite 60.5% experiencing psychological and/or relationship effects. Out of 18 who sought treatment, only 4 achieved a good response. Mean age (55.4 ± 9.5 vs 48.7 ± 10.6 years, p < 0.001) and duration of diabetes (10.9 ± 7.6 vs 5.8 ± 4.6 years, p < 0.001) were higher while eGFR was lower (73.9 ± 27.7 vs 100.51 ± 28.08 years, p < 0.008) among those with ED compared to those without. Diabetic retinopathy (4% vs 42%, p < 0.001), peripheral neuropathy (17.9% vs 38.4%, p = 0.041) and lower limb arterial disease (0% vs 12.2%, p = 0.04) were associated with ED. Arterial insufficiency was seen among 50% of the participants who underwent penile colour Doppler ultrasonography.

CONCLUSIONS

Male sexual dysfunction is a pervasive yet underappreciated problem in diabetes care despite its effect on the individual. Patient and disease characteristics would guide the identification of high-risk individuals for targeted screening in clinical practice.

Erectile dysfunction as a marker of endocrine and glycemic disorders

PURPOSE

The aim of this study was to evaluate in a population of patients with erectile dysfunction (ED): (a) the prevalence of a previously unknown endocrine/glycemic disorders; (b) the correlation between ED severity and endocrine/glycemic disorders.

METHODS

1332 patients referred for ED from 2013 to 2020 were included. The ED diagnosis was made using the International-Erectile-Function-Index-5 questionnaire. ED severity was considered according to presence/absence of spontaneous erections, maintenance/achievement deficiency. All patients were subjected to search for sociodemographic and clinical characteristics: age, ethnicity, marital status, previous use of PDE5i, previous prostatectomy, diabetes mellitus (DM), prediabetes, endocrine dysfunctions.

RESULTS

The mean ± SD age was 54.3 ± 13.7 years. The 19.1% (255/1332) of patients were already in treatment for prediabetes/diabetes or endocrine dysfunctions. Among the remaining 1077, the prevalence of previously unknown endocrine and glycemic disorders was 30% (323/1077). Among them, 190/323 subjects (58.8%) were affected by hypogonadism, with high estradiol level observed in 8/190 (4.2%). The prevalence of new glycemic alterations was 17.3% (56/323) [specifically, 32/56 (57.1%) DM, and 24/56 (42.9%) prediabetes]. A thyroid dysfunction was observed in 40/323 subjects (12.3%) and hyperprolactinemia in 37/323 (11.5%). Patients with new diagnosis of DM showed more severe form of ED compared to the total group {difficulty in the achievement of erection: 46/56 [82.2%, vs 265/1332 (19.9%), p < 0.05]; absence of spontaneous erection 23/56 [41.1%, vs 321/1332 (24.1%), p < 0.05]}.

CONCLUSION

ED is an early marker of endocrine/glycemic disorder, and a previously unknown dysfunction was found in more than a quarter of patients. A newly diagnosed DM is associated with ED severity, especially in elderly man and in presence of hypertension.

The relationship of depression, alcohol and marijuana with treatment for LUTS/BPH

INTRODUCTION

Despite widespread usage, research on the relationship of marijuana use to disease is sorely lacking. We sought to test the relationship of LUTS/BPH treatment and endocannabinoid agonist usage, as well as alcohol usage and depression, with treatment for LUTS/BPH in our health system.

MATERIALS AND METHODS

We queried our hospital system database of nearly three million patients in a marijuana-legalized region for data from the electronic medical record between January 2011 and October 2018. Men over the age of 45 on medical therapy for LUTS (selective alpha blockade and/or finasteride) were included. Exclusions were diagnosis of bladder or prostate malignancy and men with only one visit. Alcohol and marijuana (MJ) use were found from diagnosis code and/or social history text. Medical diagnoses were based on ICD-9/10 codes. Multiple logistic regression was used to control for confounders. We considered all men over the age of 45 who had any of these features: depression, obesity or metabolic syndrome (MetS), hypertension (HTN), erectile dysfunction (ED), hypogonadism, diabetes (DM) and calculated the odds ratio of also receiving medical therapy for LUTS. Univariable and multivariable analyses were employed, multiple logistic regression was used to control for confounders.

RESULTS

A total of 173,469 patients were identified meeting criteria with 20,548 (11.9%) on medical treatment for LUTS. After adjusting for confounding variables, MJ and depression remained associated with an increased risk of LUTS medication, within the context of verifying previously established relationships of ED, Obesity/MetS, DM, HTN and hypogonadism.

CONCLUSIONS

Men with depression and MJ usage were more likely to be treated for LUTS/BPH in our system. Better understanding of the causality of this relationship and potential interaction of LUTS/BPH with the endocannabinoid system is desirable.

Impact of infertility duration on male sexual function and mental health

PURPOSE

This study aimed to explore whether infertility duration has an impact on the sexual function and mental health of men from infertile couples.

METHODS

We conducted a case-control study of 558 men from infertile couples, and the participants were divided into four groups based on their infertility duration: group I: ≤ 2 years; group II: 2-5 years; group III: 5-8 years; and group IV: > 8 years. Sexual function and mental disorders were measured using the International Index of Erectile Function-15 (IIEF-15), Premature Ejaculation Diagnostic Tool (PEDT), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9) separately.

RESULTS

As the years of infertility duration increase, the total IIEF-15 score and four domains (sexual desire, orgasmic function, erectile function, and intercourse satisfaction) significantly decrease (p < 0.05). The PEDT score gradually increases significantly (p < 0.05). Increased infertility duration is an independent risk factor for erectile dysfunction and premature ejaculation (p < 0.05). However, increased infertility duration is not a risk factor for depression and anxiety (p > 0.05).

CONCLUSIONS

Our study is the first time to use the infertility duration as an independent variable and group this variable to analyze its impact on the sexual function and mental health of men from infertile couples comprehensively and systematically. The increased infertility duration is an independent risk factor for the occurrence of sexual dysfunction but not for mental disorders. In the process of infertility treatment, sexual health and mental health cannot be ignored, especially for patients with prolonged infertility.

The Association Between 2, 4-Dichlorophenoxyacetic Acid and Erectile Dysfunction

Background

2, 4-dichlorophenoxyacetic acid (2,4-D) is one of the most frequently used herbicides in the world, and it has been linked with low testosterone; however, studies regarding its effect on erectile function are limited. The current study aimed to determine the association between the 2,4-D exposure and erectile dysfunction (ED) in men from the National Health and Nutrition Examination Survey (NHANES).

Methods

We analyzed data for urinary 2,4-D levels from 1,311 men (>20 years of age) in the NHANES 2001–2004. ED was assessed by a single, validated survey question. Multivariable logistic regression analysis utilizing sampling weights was performed to determine the relationship between 2,4-D exposure and ED.

Results

Multivariable logistic regression models demonstrated no statistically significant association between 2,4-D exposure and ED after full adjustment [odds ratio (OR) 1.02; 95% CI 0.77–1.36; P = 0.882)]. Men in the 2,4-D quartile 4 groups were not associated with an increased risk of ED (OR 1.13; 95% CI 0.74–1.75; P for trend = 0.481). Furthermore, the association between urinary 2,4-D level and ED was not significant in the subgroup analysis stratified by age, BMI, cardiovascular disease, hypertension, diabetes, and high cholesterol.

Conclusion

We demonstrated that there was no association between 2,4-D exposure and ED. Further studies are warranted to corroborate our results.

Erectile Dysfunction in Relation to Metabolic Disorders and the Concentration of Sex Hormones in Aging Men

Background: The aim of this study was to analyze the relationship between the prevalence of erectile dysfunction in men as diagnosed by the International Index of Erectile Function (IIEF) questionnaire and the respective levels of sex hormones and biochemical parameters, as well as indices of visceral fat accumulation and activity. Material and Methods: The study comprised 148 male (60–75 years) patients from primary care outpatient clinics in the city of Szczecin (Poland). The men were asked to complete a shortened survey questionnaire with sociodemographic data, as well as a shortened version of the IIEF (five items). Venous blood samples were collected. Total testosterone (TT), estradiol (E2), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), total cholesterol (ChT), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), fasting plasma glucose (FPG) and albumin were determined. Lipid accumulation product (LAP) and visceral adiposity index (VAI) were calculated. Results: A correlation was found in the analysis of LAP index values (OR = 1.017; p = 0.050). The analysis of hormone concentrations showed a correlation between the diagnosed trait and the value of TT (OR = 1.216; p = 0.046) and SHBG (OR = 1.020; p = 0.007). Conclusions: VAI and LAP have been shown to be good indicators for assessing erectile dysfunction in men over 60 years of age.

The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

BACKGROUND

Erectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable.

AIM

To evaluate the prevalence of ED in the IBD population and the potential role of risk factors in the development of ED.

METHODS

An extensive search in the PubMed, Cochrane Library, and Web of Science was performed to identify relevant English-language articles published up to December 2021 that evaluated the prevalence of ED on IBD patients. The included studies were evaluated by 2 independent reviewers for eligibility. We used an adapted Assessment Tool for Prevalence Studies to evaluate the quality of enrolled studies. Data were analyzed and graphed using the STATA software (version 16.0; Stata Corporation, College Station, TX, USA). The ORs with 95% CIs were pooled using a fixed or random-effects model according to heterogeneity. Subgroup analysis was performed to explore the source of heterogeneity. Sensitivity analysis was conducted to evaluate the stability of the results.

OUTCOMES

The pooled prevalence of ED in IBD patients was calculated, and the OR value and 95% CIs were used to assess the strength of the association between IBD-related risk factors and ED.

RESULTS

Fourteen studies included 32,858 individuals totally were enrolled for this meta-analysis. The overall pooled prevalence estimate of ED in IBD patients was 27% (95% CI: 20-34%). Operation (OR 1.28; 95% CI: 1.17-1.39; P < .00001; I2 = 0.0%), disease activity (OR 2.06; 95% CI: 1.07-3.05; P < .00001), and depression (crude OR 3.31; 95% CI: 1.08-5.54; P = .004; I2 = 0.0%) significantly increase the risk of ED in people with IBD. The association of depression and ED was further confirmed by calculating the pooled estimates of adjusted OR (1.58; 95% CI: 0.05-3.12; P < .05; I2 = 0.0%). The pooled prevalence estimates of ED were 30, 33, and 17% in the age <40, IIEF diagnostic tool, and IPAA surgery subgroups, respectively.

CLINICAL IMPLICATIONS

IBD patients had a significantly increased prevalence of ED, indicating that erectile function in men with IBD should be concerned by clinicians.

STRENGTHS & LIMITATIONS

The strength of this study is that this is the first meta-analysis to assess the global prevalence and risk factors of ED in IBD patients. A limitation is that the results after pooling the included articles showed significant heterogeneity.

CONCLUSION

The results of our meta-analysis and systematic review provide evidence of the high prevalence and risk factors of ED in IBD patients. Wu X, Zhang Y, Zhang W, et al. The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Sex Med 2022;19:950-960.

Erectile dysfunction in young patients and elderly patients by sexual encounter profile: A comparative study

OBJECTIVE

Demand for erectile dysfunction treatments has increased not only in elderly patients but also in young patients. Reports indicate that frequent causes of erectile dysfunction in Japan are organic disorders in elderly patients and psychogenetic disorders in young patients.

METHODS

We defined patients under the age of 40 as young erectile dysfunction patients, and those over 65 as elderly erectile dysfunction patients. We divided these two groups and conducted a retrospective comparative study based on medical questionnaires. We selected 215 cases of patients under the age of 40, and 176 cases of patients over the age of 65, and created a group of young patients and a group of elderly patients. We implemented the erectile hardness score, Sexual Health Inventory for Men, and sexual encounter profile questions 2 and 3 as the patient's daily clinical journal.

RESULTS

The median age of young patients was 36 years, and that of elderly patients was 70 years. With respect to Sexual Health Inventory for Men, the average score was a significantly higher score in the young patients (9.26 vs 7.10, P < 0.001). Concerning erectile hardness score, young patients showed significantly higher scores in erectile hardness score (3.15 vs 2.06, P < 0.001). In terms of sexual encounter profile question 2, 50.9% of young patients responded "yes," but 24.3% of elderly patients responded, thus indicating a significantly higher score in young patients. In terms of sexual encounter profile question 3, 6.1% of young patients responded "yes," and 0.7% of elderly patients responded "yes," indicating a significantly higher in young patients.

CONCLUSIONS

The results showed that many young patients with erectile dysfunction were able to perform insertion, but were unable to maintain erection.

[Sexual, physical, mental and sleep sequelae four months after SARS-CoV-2 disease]

BACKGROUND

Long term sequelae can be observed after SARS-CoV2.

AIM

To describe the sexual, physical, mental and sleep sequelae four months after SARS-CoV2 diagnosis.

PATIENTS AND METHODS

Patients recovering from SARS-CoV2 with different degrees of disease severity were consecutively included and separated in two study groups, namely Group 1 including patients that had an acute respiratory distress syndrome (ARDS) and Group 2 including those with mild or moderate COVID-19. Handgrip strength, respiratory polygraphy (RP), Quality of life using the SF-12 questionnaire, and the international index of erectile (IIEF-5) function were assessed.

RESULTS

Twenty patients who had ARDS, and 10 without ARDS were included. Erectile dysfunction was observed in 77 and 10% of patients with and without ARDS, respectively (p < 0.01). The figures for sleep obstructive apnea were 82 and 40% respectively (p = 0.02) and for the physical domain SF-12 score were 39.2 and 47.9 points respectively (p = 0.01). No differences in muscle strength were observed. After a multivariable analysis, previous ARDS due to COVID-19 was independently associated with erectile dysfunction, with an odds ratio of 30.6 (95% confidence intervals, 3.08300.3, p = 0.003).

CONCLUSIONS

Among men with ARDS due to COVID-19, the prevalence of erectile dysfunction was high and independently associated with a severe disease four months after discharge.

Prevalence and associated factors of erectile dysfunction in men with type 2 diabetes mellitus in eastern Sudan

BACKGROUND

Diabetes mellitus (DM) is a global health threat and burden that is associated with many chronic complications. Erectile dysfunction (ED) among patients with DM is one of these complications. There is no published data on ED in Sudan; hence, we conducted this study to evaluate the prevalence of ED and the associated factors in patients with type 2 diabetes mellitus (T2DM) in eastern Sudan.

METHODS

We performed a cross-sectional study. Data on blood glucose level, cholesterol level, anthropometric and demographic characteristics, results of the International Index of Erectile Function (IIEF-5) questionnaire, and clinical history were obtained.

RESULTS

A total of 334 men with T2DM with a median (interquartile range [IQR]) age of 55.0 (±10.0) years were enrolled in the study. The median (IQR) of the duration of DM was 7.0 (±8) years, and 260 (77.8%) had uncontrolled T2DM. The median (IQR) body mass index was 24.5 (±4.9) kg/m2. Of the participants, 81 (24.3%) had severe ED, 52 (15.6%) had moderate ED, 75 (22.5%) had mild to moderate ED, and 63 (13.9%) had mild ED. Of the 334 men, 271 (81.1%) had ED. Logistic regression analysis showed that age (adjusted Odds Ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.01-1.14), duration of DM (AOR = 1.26, 95% CI = 1.06-1.51), and cholesterol levels (AOR = 3.53, 95% CI = 1.75-7.11) were positively associated with ED. Moreover, poor glycaemic control (AOR = 3.38, 95% CI = 1.70-6.71, P < 0.001) was significantly associated with ED.

CONCLUSION

There is a high prevalence of ED among patients with T2DM in eastern Sudan. Age, duration of DM, and cholesterol were positively associated with ED.

Increased odds ratio for erectile dysfunction in COVID-19 patients

PURPOSE

Erectile dysfunction and COVID-19 share similar risk factors, including vascular disruption of integrity, cytokine release, cardiovascular disease, diabetes and obesity. The aim of this study was to investigate the association between erectile dysfunction and COVID-19 patients.

METHODS

Odds ratio for erectile dysfunction in patients with a history of COVID-19 with and without comorbidities were calculated using a patients' registry platform i2b2. ICD-10 diagnoses codes were accessed for queries and data were analyzed using logistic regression.

RESULTS

Patients with COVID-19 were 3.3 times more likely to have erectile dysfunction with 95% CI (2.8, 3.8). The association became stronger with odds ratio 4.8 (95% CI (4.1, 5.7)) after adjusting for age groups. The odds ratio remained the same after adjusting for smoking status with 3.5 (95% CI (3.0, 4.1)). After adjusting for race, COVID-19 patients were 2.6 (95% CI (2.2, 3.1)) times more likely to have erectile dysfunction. The odds ratio were 1.6, 1.8, 1.9 and 2.3 after adjusting for respiratory disease, obesity, circulatory disease and diabetes, respectively.

CONCLUSION

COVID-19 and erectile dysfunction are strongly associated even after adjustment for known risk factors and demographics.

The Epidemic of COVID-19-Related Erectile Dysfunction: A Scoping Review and Health Care Perspective

INTRODUCTION

COVID-19 infection is expected to be associated with an increased likelihood of erectile dysfunction (ED). Considering the high transmissibility of COVID-19, ED may be a concerning consequence for a large segment of the population.

AIMS

To (1) summarize existing published evidence for the impact of COVID-19 on the prevalence, severity, treatment, and management of ED; and (2) identify health-related trends in the emerging literature and identify gaps in the existing research literature and make recommendations for future research needs in the area.

METHODS

A scoping literature search was conducted on April 27, 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR) checklist was followed. The literature search was performed in PubMed using the terms: COVID-19, erectile, sexual, and dysfunction. A total of 693 publications were screened for relevance. Studies were appraised for their level of evidence based on study design and the rigor of methodology.

RESULTS

The evidence that COVID-19 infection causes or impacts ED is compelling. Four topics emerged regarding the nature of the association between COVID-19 and ED: (1) the biological impact of COVID-19 infection on ED; (2) the mental health impact of COVID-19 on ED; (3) the impact of COVID-19 on the management of ED and access to ED treatment; and (4) health disparities and the impact of COVID-19 on ED. Long-term and well-designed studies are needed to clarify the extent of the impact of COVID-19 on ED. The pandemic exposed several vulnerabilities within worldwide healthcare and social systems.

CONCLUSION

COVID-19 has a uniquely harmful impact on men's health and erectile function through biological, mental health, and healthcare access mechanisms. As the pandemic wanes, strategies to identify long-term effects and additional health care support may be needed to adequately mitigate the impact of COVID-19 on men's health. Hsieh T-C, Edwards NC, Bhattacharyya SK, et al.The Epidemic of COVID-19-Related Erectile Dysfunction: A Scoping Review and Health Care Perspective. Sex Med Rev 2022;10:286-310.

Effects of Chronic Migraine on Male Sexual Health

OBJECTIVE

To investigate the clinical implication of the sexual functions of male patients diagnosed with chronic migraine (CM) compared with the healthy population.

STUDY DESIGN

Observational study.

PLACE AND DURATION OF STUDY

Departments of Urology and Neurology, Hitit University Hospital, Turkey, from August 2019 to August 2020.

METHODOLOGY

A total of 179 patients (92 subjects diagnosed with CM and 87 control healthy volunteers) were included in this study. Demographic descriptive data including age, height, weight, and body mass index (BMI) of all patients were recorded. A 5-question version of the international index of erectile function questionnaire (IIEF-5) was applied to evaluate their sexual functions. Furthermore, a migraine identification test was performed for CM patients for the diagnosis of migraine in accordance with the International Headache Society's (IHS) definition of chronic migraine. Visual analog scale (VAS) scores between 0-10 points were recorded for the qualitative assessment of migraine pain.

RESULTS

The IIEF-5 scores of CM patients [16 (11 - 21)] were lower compared to the control patients [21 (19 - 23), p <0.001)]. A negative correlation was found between the VAS scores and IIEF-5 scores of CM patients (rho -0.582, p <0.001). In the regression analysis, it was found that a 1-unit increase in the VAS score led to a 1.5 point decrease in the IIEF-5 score (p <0.001).

CONCLUSION

Migraine pain in male patients with CM adversely affected erectile functions. A more detailed investigation of the pathophysiological mechanisms may be helpful in the treatment of ED.

KEY WORDS

Erectile dysfunction, Chronic migraine, IIEF-5, Erectile functions.