Current epidemiology of erectile dysfunction, an update

Associations between sexually submissive and dominant behaviors and sexual function in men and women

The current study investigated the associations between sexually submissive and dominant behaviors and sexual dysfunction in Finnish men and women. We analyzed three population-based data sets from 2006, 2009, and 2021-2022, including 29,821 participants in total. Participants filled out a questionnaire about their sexually submissive and dominant behaviors, Sexual Distress Scale, Checklist for Early Ejaculation Symptoms and International Index of Erectile Function Questionnaire-5 (men), and Female Sexual Function Index (women). Pearson Correlations showed that for both sexes, sexually submissive (men: r = 0.119, p < 0.001; women: r = 0.175, p < 0.001) and dominant (men: r = 0.150, p < 0.001; women: r = 0.147, p < 0.001) behaviors were both associated with more sexual distress. However, for men, sexually submissive (r = -0.126, p < 0.001) and dominant behaviors (r = -0.156, p < 0.001) were associated with less early ejaculation symptoms. Both sexually submissive (r = 0.040, p = 0.026) and dominant behaviors (r = 0.062, p < 0.001) were also associated with better erectile function while sexually dominant behavior alone was associated with better orgasmic function (r = 0.049, p = 0.007), intercourse satisfaction (r = 0.068, p < 0.001), and overall satisfaction (r = 0.042, p = 0.018). For women, both sexually submissive (r = 0.184, p < 0.001) and dominant behaviors (r = 0.173, p < 0.001) were also associated with better overall female sexual function. One possible explanation is that these individuals have a clear idea of what they prefer sexually facilitating arousal. Particularly, sexually submissive behavior may reduce high-level self-awareness and, in this way, contribute to reduced performance anxiety. However, non-normative interests seem to simultaneously result in increased sexual distress probably due to the absence of self-acceptance. Further research about the causal mechanisms between non-normative sexual interest and sexual function is needed.

Erectile dysfunction and associated factors among patients with diabetes in Public hospitals of Harari region, Eastern Ethiopia: modified poisson regression model

BACKGROUND

Erectile dysfunction is a common problem among patients with diabetes, often going undiagnosed and having a significant negative impact on their health. This condition necessitates accurate evaluation and early intervention. However, there is an inconsistent explanation of factors and limited evidence on the prevalence of erectile dysfunction among patients with diabetes in eastern Ethiopia. Thus, this study aimed to determine the prevalence of erectile dysfunction and its associated factors among patients with diabetes in public hospitals in the Harari Region, eastern Ethiopia.

METHODS

A cross-sectional study was conducted involving 339 randomly selected participants. Data were collected using the Kobo Toolbox with standardized questionnaires administered by interviewers, along with a review of the patients' medical records. Data analysis was performed using Stata version 14. The Poisson regression model with robust variance estimate was fitted to examine the association of the independent variables and erectile dysfunction. An adjusted prevalence ratio (APR) with 95% confidence intervals was reported. Statistical significance was declared at the p-value < 0.05.

RESULT

The prevalence of erectile dysfunction was 78.28% (95% CI 73-83). Age 35-45 years [APR = 1.38; 95% CI: 1.03-1.84], and > 45 years [APR = 1.58; 95% CI 1.17-2.13], depression [APR = 1.41; 95% CI 1.06-1.86], current khat use [APR = 1.14; 95% CI 1.00-1.28], low social support [APR = 1.70; 95% CI 1.09-2.65] and medium social support [APR = 1.79; 95% CI 1.16-2.78] were factors significantly associated with erectile dysfunction.

CONCLUSIONS

More than three-fourths of the participants had erectile dysfunction. Significant factors associated with erectile dysfunction included age 35 years and above, depression, current hat use, and low and medium social support level. The management of erectile dysfunction should be integrated into routine medical care in diabetic follow-up clinics, with special attention for those participants aged 35 years and above, who have depression, currently use Khat, and have low-level social support.

Mechanism associated with changes in male reproductive functions during ageing process

Ageing is a natural process with physiological changes in different body parts and has been associated with decreased reproductive capacity. Factors such as imbalance in the antioxidant defence system, vascular diseases, diabetes mellitus, accessory reproductive glands infection, obesity as well as buildup of toxic substances play a role in age-related male reproductive malfunction. Age is inversely proportional to volume of semen, sperm count, sperm progressive motility, sperm viability, normal sperm morphology. The observed negative correlation between ageing and semen indices contributes to male infertility and reproductive decline. Normal levels of ROS, plays crucial role in facilitating sperm function, such as capacitation, hyper-activation, acrosome reaction as well as sperm-oocyte fusion; however, a substantial elevation in the endogenous level of ROS, especially in reproductive tissues, usually instigates destruction of sperm cells and heightened male infertility. Contrarily, antioxidants, such as vitamins C and E, beta-carotene, and micronutrients like zinc and folate, have been found by researchers to facilitate normal semen quality and male reproductive function. Furthermore, the role of hormonal imbalance as a result of the compromised hypothalamic-pituitary-gonadal axis, Sertoli and Leydig cells disorder, and nitric oxide-medicated erectile dysfunction during ageing cannot be undermined.

Understanding the age-related alterations in the testis-specific proteome

INTRODUCTION

Fertility rates in developing countries have declined over the past decades, and the trend of delayed fatherhood is rising as societies develop. The reasons behind the decline in male fertility with advancing age remain mysterious, making it a compelling and crucial area for further research. However, the limited number of studies dedicated to unraveling this enigma poses a challenge. Thus, our objective is to illuminate some of the upregulated and downregulated mechanisms in the male testis during the aging process.

AREAS COVERED

Herein, we present a critical overview of the studies addressing the alterations of testicular proteome through the aging process, starting from sexually matured young males to end-of-life-expectancy aged males. The comparative studies of the proteomic testicular profile of men with and without spermatogenic impairment are also discussed and key proteins and pathways involved are highlighted.

EXPERT OPINION

The difficulty of making age-comparative studies, especially of advanced-age study subjects, makes this topic of study quite challenging. Another topic worth mentioning is the heterogeneous nature and vast cellular composition of testicular tissue, which makes proteome data interpretation tricky. The cell type sorting and comorbidities testing in the testicular tissue of the studied subjects would help mitigate these problems.

Erectile dysfunction predictors in hypertensives at a primary care clinic in Southern Nigeria

BACKGROUND

 Erectile dysfunction (ED) has been described as an important public health problem by the National Institutes of Health Consensus Development Conference Panel. It causes significant distress in men and dysfunctional family dynamics.

AIM

 This study sought to identify the relationship between level of education and ED amongst hypertensive men (aged 30-89 years) attending outpatient clinics (OPCs) at the Federal Medical Centre (FMC), Asaba.

SETTING

 This study was conducted in the OPCs at FMC, Asaba, Delta State, Nigeria.

METHODS

 After obtaining approval from the ethics and research committees in Asaba, 184 consenting hypertensive men who met the eligibility criteria were selected by systematic random sampling to participate in the study from October 2015 to January 2016. This study was a cross-sectional survey. Data were collected with a semistructured, interviewer-administered questionnaire adopted from the International Index of Sexual Health Inventory for Men. The study complied with the principles of Helsinki and Good Clinical Practice.

RESULTS

 The mean age ± standard deviation and range of the respondents were 55.1 (±12.4) and 30-89 years, respectively. On logistic regression, higher level of education (secondary school and above) (odds ratio [OR] = 15.943, 95% confidence interval [CI] = 1.517-167.502) was found to be a predictor of ED amongst the study participants.

CONCLUSION

 This study showed that formal education up to secondary level and use of diuretics were significantly associated with ED amongst adults with hypertension.

Perspectives on sexual history taking in routine primary care consultations in North West, South Africa: Disconnect between patients and doctors

Background: Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking.Aim: This study aimed to explore doctors’ and patients’ perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction.Setting: The research was conducted in primary care facilities in the Dr Kenneth Kaunda Health District, North West province.Methods: This was part of grounded theory research, involving 151 adult patients living with hypertension and diabetes and 21 doctors they consulted. Following recording of routine consultations, open-ended questions on the demographic questionnaire and brief interactions with patients and doctors were documented and analysed using open inductive coding. The code matrix and relations browsers in MaxQDA software were used.Results: There was a disconnect between patients and doctors regarding their expectations on initiating the discussion on sexual challenges and relational and clinical priorities in the consultation. Patients wanted a doctor who listens. Doctors wanted patients to tell them about sexual dysfunction. Other minor barriers included gender, age and cultural differences and time constraints.Conclusion: A disconnect between patients and doctors caused by the doctors’ perceived clinical priorities and screening expectations inhibited sexual history taking in a routine consultation in primary care.

Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked

Background

Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction.

Aim

This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations.

Setting

The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas.

Methods

One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data.

Results

Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time.

Conclusion

Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care.

Preparation and evaluation of radioiodinated avanafil: A novel potential radiopharmaceutical for the diagnostic evaluation of erectile dysfunction

Avanafil, a selective second-generation phosphodiesterase-5 inhibitor, was successfully labeled with iodine-125 via electrophilic and different factors affecting the labeling efficiency were studied. The labeled compound exhibited in-vitro stability of more than 24 h with a maximum labeling yield of up to 98.4 ± 1.9 %. Molecular modeling and in-vitro assessment of tracer inhibitory activity were performed to ensure that radiolabeling did not affect its binding ability to the target. Biodistribution studies were performed in normal rats and models of erectile dysfunction. The tracer specifically accumulated in the penis, and the clearance appeared to take place via the hepatobiliary route. Results suggested the usefulness of radiolabeled avanafil as a promising tracer for erectile dysfunction.

A preliminary study of the efficacy of the polyherbal preparation Sao Thong Tai for erectile dysfunction among elderly men: a double-blind, randomized controlled trial

Background

The traditional Thai polyherbal formulation “Sao Thong Tai” (STT) contains four medicinal plants, namely Boesenbergia rotunda (L.) Mansf., Sida acuta Burm.f., Dactyloctenium aegyptium (L.) Willd., and Oryza sativa L. and it is considered an aphrodisiac and remedy for the effective treatment of decreased male libido in Thai traditional medicine and it may ameliorate erectile function. This pilot study was carried out to investigate the efficacy and safety of the polyherbal STT for mild to moderate erectile dysfunction in a small group of elderly men in Thailand in a double-blind, randomized controlled trial.

Methods

This research is a preliminary study. Fifty-four elderly males aged 50-69 years who had been diagnosed with mild to moderate ED were randomized into two groups of equal size: an STT group (n=27) and a placebo control group (n=27). The patients received either an 800 mg dose of STT extract or a lactose placebo twice a day for the eight-week treatment period, after which they were followed up for four weeks. Erectile function, sexual activity, self-reported attitudes toward sexual dysfunction, and partner-reported sexual dysfunction were investigated to confirm the efficacy of the polyherbal preparation. The International Index of Erectile Function (IIEF-5) and the Scale for Quality of Sexual Function (QSF) were used for primary outcome assessment.

Results

The IIEF-5 scores of the STT group were significantly increased compared with those of the placebo group (p<0.001). The severity of ED decreased from "mild" or "mild to moderate" to normal in 88.9% of the STT group vs. 0% of the placebo group, and the QSF score increased in the STT group (p<0.001). Sexual activity, self-reported views of sexual dysfunction, and partners’ views of sexual dysfunction showed significant improvement in the STT group, and there was no significant difference in psychosomatic quality of life. No adverse events were observed in either group.

Conclusion

Compared with a placebo, an oral aqueous extract of STT taken daily at a dose of 1,600 mg for eight weeks can effectively treat mild to moderate ED in elderly men. The preparation was also shown to be safe with respect to all parameters assessed. This finding demonstrates that STT can be used for the effective treatment of decreased male libido in Thai traditional medicine and may ameliorate ED.

Trial registration

TCTR/20180126001 033/2560. Registered 16 January 2018, Thai Clinical Trials Registry http://www.thaiclinicaltrials.org/

Indications and characteristics of penile traction and vacuum erection devices

A variety of devices are available for the management of patients with erectile dysfunction, Peyronie's disease, penile dysmorphophobia, for support before and after penile prosthesis insertion, and after radical prostatectomy. Traction devices include, but are not limited to, Penimaster PRO (MSP Concept, Berlin, Germany), Andropenis and Andropeyronie (Andromedical, Madrid, Spain), and the Restorex (PathRight Medical, Plymouth, USA). The other type of devices are vacuum devices such the Osbon ErecAid (Timm Medical, MN, USA). Different devices are optimal for different clinical applications, and robust and contemporary clinical data show a variety of strengths and weaknesses for each device. Research currently favours the use of traction devices for improvement of penile curvature and erectile function in patients with Peyronie's disease compared with vacuum devices; Penimaster Pro and Restorex have been shown to be associated with the best outcomes in this indication. Vacuum devices are favoured for treatment of erectile dysfunction and penile length loss after radical prostatectomy; the Osbon ErecAid is the most well-studied device for this indication. Research into other uses of vacuum and traction devices, such as for penile dysmorphophobia or before and after penile prosthesis, is very limited. Compliance, cost and availability remain substantial challenges, and further high-quality evidence is required to clarify the role of traction devices in urology and sexual medicine.

Phytochemical Screening by LC-ESI-MS/MS and Effect of the Ethyl Acetate Fraction from Leaves and Stems of Jatropha macrantha Müll Arg. on Ketamine-Induced Erectile Dysfunction in Rats

Jatropha macrantha Müll Arg. L is also known as “huanarpo macho” and used in the Peruvian traditional medicine as an aphrodisiac and erectile dysfunction (ED). The aim of this study was to determine the phytochemical constituents in leaves and stems ethyl acetate fraction (LEAF and SEAF) of J. macrantha and to compare the antioxidant activity and the ameliorative effect on ketamine-induced erectile dysfunction in rats. The phytochemical constituents were determined by LC-ESI-MS/MS, the total phenolic compounds and total flavonoids (TPC and TF) by Folin-Ciocalteu and aluminum chloride, respectively. The antioxidant activity was determined by DPPH, ABTS, and FRAP assays. Experimental groups were divided as follows: I: negative control; II: positive control (ketamine at 50 mg/ kg/d); III: sildenafil 5 mg/kg; IV, V, VI: LEAF at 25, 50 and 100 mg/kg, respectively, and VII, VIII, IX: SEAF at 25, 50, and 100 mg/kg, respectively. The phytochemical analysis revealed the presence mainly of coumarins, flavonoids, phenolic acids, and terpenes. TPC of LEAF and SEAF were 359 ± 5.21 mg GAE/g and 306 ± 1.93 mg GAE/g, respectively; TF in LEAF and SEAF were 23.7 ± 0.80 mg EQ/g, and 101 ± 1.42 mg EQ/g, respectively. The DPPH, ABTS, FRAP in SEAF were 647 ± 3.27; 668 ± 2.30; and 575 ± 2.86 μmol TE/g, respectively, whilst LEAF showed 796 ± 3.15; 679 ± 0.85; and 806 ± 3.42 μmol TE/g, respectively. Regarding sexual behavior, LEAF showed a better effect in mount frequency, intromission frequency, ejaculation frequency, mount latency, intromission latency, ejaculatory latency, and post ejaculatory latency than SEAF. As conclusion, LEAF of J. macrantha at 50 mg/kg showed a better effect on sexual behavior in male rats with erectile dysfunction than SEAF but not higher than sildenafil.

Metacognitions in heterosexual, bisexual, and homosexual men: with or without premature ejaculation and erectile dysfunction

BACKGROUND

Premature ejaculation (PE) and erectile dysfunction (ED) are prevalent sexual problems, with evidence to suggest variation across sexual orientation. Contributing factors have traditionally been divided into organic and psychological categories. While limited research has found support for the influence of metacognitive beliefs, these studies did not investigate potential differences in sexual orientation.

AIM

The current study aimed to investigate the differences in metacognitive beliefs in men with or without PE and/or ED and whether these varied according to sexual orientation.

METHOD

A sample of 531 men was recruited (65 met criteria for PE only, 147 for ED, 83 with PE and ED, and 236 healthy controls). Within this sample, 188 men identified as heterosexual, 144 as bisexual, and 199 as homosexual. Participants completed a cross-sectional online survey consisting of psychometric measures.

RESULTS

Participants with PE and ED were significantly higher in cognitive confidence, thoughts concerning uncontrollability and danger, and need to control thoughts than PE only, ED only, and healthy controls. Furthermore, the PE only group was significantly higher than healthy controls for cognitive confidence, with the ED significantly higher for thoughts concerning uncontrollability and danger. There were no significant differences between differing sexual orientations for men with/or without PE and/or ED.

CONCLUSIONS

Congruent with previous research, metacognitive beliefs play a role in PE and/or ED, although this is not exclusive to sexual orientation. The findings highlight that assessment and intervention regarding metacognitive beliefs may be beneficial for men of all sexual orientations with PE and/or ED.

Pharmacological treatment and inappropriate prescriptions for patients with erectile dysfunction

Background Erectile dysfunction is associated with old age, some morbidities and the use of certain medications. Objective To identify the treatments and drugs related to worsening sexual activity in patients with erectile dysfunction. Setting Patients diagnosed with erectile dysfunction during 2018. Methods This cross-sectional study of a population database identified all drug prescriptions of patients with erectile dysfunction during 2018. Main outcome measure The identification of other comorbidities and potentially inappropriate drugs that could worsen erectile dysfunction. Results A total of 2999 patients with erectile dysfunction (mean age 59.6 ± 12.1 years) were identified. A total of 88.2% received pharmacological treatment for erectile dysfunction, mainly tadalafil (70.5%). A total of 47.6% of all patients received at least one medication associated with worsening erectile dysfunction, especially hydrochlorothiazide (17.0%), metoprolol (7.9%) and sertraline (6.7%). Residing in Cali (OR 1.86; 95% CI 1.52-22.27) or Bucaramanga (OR 2.23; 95% CI 1.39-33.58), having 3 or more chronic comorbidities (OR 1.52; 95% CI 1.04-2.24) and presenting psychiatric (OR 5.5; 95% CI 3.70-8.17), cardiovascular (OR 3.48; 95% CI 2.79-4.33), genitourinary (OR 1.31; 95% CI 1.05-1.64) pathologies or chronic kidney failure (OR 1.84; 95% CI 1.18-2.21) elevated the probability of receiving these prescriptions. Conclusions The pharmacological treatment of erectile dysfunction was in accordance with the recommendations of clinical practice guidelines, but the high proportion of potentially inappropriate prescriptions makes it necessary to promote educational and pharmacovigilance strategies that improve the prescription habits of physicians involved in caring for this group of patients.

Increased Rate of Sexual Dysfunction by Increased Severity of Nasal Obstruction in Patients With Chronic Rhinosinusitis

OBJECTIVES

Chronic rhinosinusitis (CRS) is a common chronic respiratory disorder. This study aimed to investigate the relation between nasal obstruction and sexual dysfunction in men with CRS.

METHODS

In this case-control study, 100 married men aged 19 to 48 years with CRS and 56 healthy married men were selected, consecutively. For assessment of nasal obstruction severity NOSE scale (Nasal Obstruction Symptom Evaluation) was used and IIEF (International Index of Erectile Function) inventory was used to assess sexual function.

RESULTS

Mean age of patients with CRS and controls was 33.25 ± 6.5 and 30.58 ± 7.12 years, respectively. Nasal obstruction was moderate in 70% of patients and 95% of patients had some degrees of erectile dysfunction. A significant association was found between nasal obstruction severity and sexual function and by increasing severity of nasal obstruction, sexual function decreased significantly in CRS patients. Sexual function in total (IIEF score) and in its domains, except for sexual desire, were significantly higher in control group (P < .05).

CONCLUSION

There is significant inverse association between severity of nasal obstruction and sexual function. Sexual function decreases with increasing severity of nasal obstruction in CRS. CRS patients also have lower sexual function scores than healthy control males.

Risk factors of erectile dysfunction among diabetes patients in Africa: A systematic review and meta-analysis

Background

Erectile dysfunction in men is a common underestimated complication of diabetes mellitus, which is becoming a significant public health problem both in developing and developed countries. Erectile dysfunction threatens the well-being of clients, hence determining its risk factors and controlling it at an early stage is vital to preventing serious consequences and the burden of the disease. Therefore, this study aimed to systematically evaluate erectile dysfunction risk factors in patients with diabetes mellitus in Africa.

Methods

PubMed, Web of Science, Scopus, African Journals Online, Wiley Online Library and Google Scholar were searched and complemented by manual searches. Egger's regression test was used to determine publication bias. The I² statistic was used to check heterogeneity between the studies. DerSimonian and Laird random-effects model was applied to estimate pooled effect size, odds ratios, and 95% confidence interval across studies. STATA version 14 statistical software was used for the meta-analysis.

Result

Overall, 17 studies with 6002 study participants were included to identify risk factors of erectile dysfunction among diabetic patients. Duration of diabetes mellitus >10 years (AOR = 2.63; 95% CI 1.27, 5.43), age >40 years (AOR = 1.24; 95% CI: 1.03, 1.51), peripheral neuropathy (AOR = 2.34; 95% CI: 1.51, 10.72), no physical exercise (AOR = 1.63; 95% CI: 1.49, 1.78), testosterone level <8 nmol/l (AOR = 2.83; 95% CI: 1.06, 12.86), and peripheral vascular disease (AOR = 2.85, 95% CI: 1.54–5.27) were significantly associated with erectile dysfunction among diabetic patients.

Conclusions

This study found that long duration of diabetes mellitus, age >40 years, testosterone deficiency, peripheral neuropathy, not involved in physical exercise, peripheral vascular disease, were significantly associated with increased risk of erectile dysfunction among diabetic patients Therefore, situation-based interventions and country context-specific preventive strategies should be developed to decrease the risk factors of erectile dysfunction among patients with diabetes mellitus.

Effects of a high energy density diet in the "corpus cavernosum" of mice

Erectile dysfunction is a common condition that affects men over age 40. It is highly related to obesity. The corpus cavernosum is the most important structure involved in erection. The aim of this study was to evaluate the structure of the corpus cavernosum of mice fed with a high energy density diet (HED). At 3 months of age, male C57BL/6 mice were fed with a HED diet (50% lipids) or standard chow (SC) diet (10% lipids) for 14 weeks. Afterwards, the animals were euthanized and the corpus cavernosum was analyzed through stereology. Statistical significance was calculated by the student's t-test (p < 0.05). The group fed with HED diet showed higher values of body weight, blood pressure and higher rates of cholesterol, triglycerides, and glucose from the second week to the end of the experiment. The HED group showed a significant increase in the connective tissue (15%) and a decrease in smooth muscle fibers (41%). The testosterone concentration in the HED group was 63% lower than in SC animals. Animals fed with a HED presented reduced testosterone serum levels and morphological changes on the corpus cavernosum, which may be related to erectile dysfunction.