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Zizzo J, Gater DR, Hough S, Ibrahim E. Sexuality, Intimacy, and Reproductive Health after Spinal Cord Injury. J Pers Med 2022; 12:jpm12121985. [PMID: 36556205 PMCID: PMC9781084 DOI: 10.3390/jpm12121985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Spinal cord injury (SCI) is a life-altering event often accompanied by a host of anxiety-provoking questions and concerns in the minds of affected individuals. Questions regarding the ability to resume sexual activity, partner's satisfaction as well as the ability to have biological children are just a few of the unknowns facing patients following the devastating reality that is SCI. As a result of advances in SCI research over the last few decades, providers now have the knowledge and tools to address many of these concerns in an evidence-based and patient-centered approach. SCI can impair multiple components involved in sexual function, including libido, achieving and maintaining an erection, ejaculation, and orgasm. Many safe and effective fertility treatments are available to couples affected by SCI. Finally, learning to redefine one's self-image, reinforce confidence and self-esteem, and feel comfortable communicating are equally as important as understanding functionality in regaining quality of life after SCI. Thus, this review aims to highlight the current state of SCI research relating to sexual function, reproductive health, and the search for meaning.
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Affiliation(s)
- John Zizzo
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - David R. Gater
- Department of Physical Medicine & Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Sigmund Hough
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA 02215, USA
- Department of Psychiatry, Boston University School of Medicine, Boston University, Boston, MA 02118, USA
| | - Emad Ibrahim
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence:
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Ali A, Ibrahim E. Sexual Dysfunction After Spinal Cord Injury. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Afferi L, Pannek J, Louis Burnett A, Razaname C, Tzanoulinou S, Bobela W, da Silva RAF, Sturny M, Stergiopulos N, Cornelius J, Moschini M, Iselin C, Salonia A, Mattei A, Mordasini L. Performance and safety of treatment options for erectile dysfunction in patients with spinal cord injury: A review of the literature. Andrology 2020; 8:1660-1673. [PMID: 32741129 DOI: 10.1111/andr.12878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND For a large proportion of patients with spinal cord injury, sexuality and reproduction are important issues. However, sparse data exist regarding available treatment options for this patient population. OBJECTIVES We sought to review performance and safety rates of all currently available treatment options for erectile dysfunction in spinal cord injury men. MATERIALS AND METHODS A systematic literature review without time restrictions was performed using PubMed/EMBASE database for English-, Italian-, German-, and Spanish-language articles. Articles' selection was performed according to the PRISMA guidelines. Relevant papers on erectile dysfunction in spinal cord injury patients were included in the final analyses. RESULTS AND DISCUSSION Overall, 47 studies were eligible for inclusion in this review. Of these, most evidence dealt with phosphodiesterase 5-inhibitors and intracavernous drug injection. Both treatment options are associated with high levels of performance and with patients/partners' satisfaction; side effects are acceptable. Overall, penile prostheses and vacuum erection devices are in general less approved by spinal cord injury patients and are correlated with increased rates of complications in comparison with phosphodiesterase 5-inhibitors and intracavernous drug injection. Sacral neuromodulation, transcutaneous electrical nerve stimulation, and intraurethral suppositories have been poorly studied, but preliminary studies did not show convincing results. CONCLUSION The best treatment options for erectile dysfunction in spinal cord injury patients emerged to be phosphodiesterase 5-inhibitors and intracavernous drug injection. The choice of erectile dysfunction treatment should be based on several aspects, including residual erectile function, spinal cord injury location, and patients' comorbidities. Future studies assessing the applicability of less well-studied treatments, as well as evaluating innovative options, are needed in this specific population.
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Affiliation(s)
- Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Schweizer Paraplegiker Zentrum, Nottwil, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arthur Louis Burnett
- Department of Urology, John Hopkins Hospital, Brady Urological Institute, Baltimore, MA, USA
| | | | | | | | | | - Mikael Sturny
- Comphya SA, EPFL Innovation Park, Lausanne, Switzerland
| | | | - Julian Cornelius
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christophe Iselin
- Division of Urology, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
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The Effect of Exercise on Sexual Satisfaction and Sexual Interest for Individuals with Spinal Cord Injury. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09654-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
STUDY DESIGN Observational study (Ethics Committee Number 973.648). OBJECTIVE Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction. SUMMARY OF BACKGROUND DATA Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation. METHODS Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level. RESULTS Forty-five subjects with mean injury time of 7.5 years (CI 5.2-9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07-0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02-0.66), masturbation (OR: 0.13; 95% CI: 0.02-0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01-0.92). Ejaculation (OR: 0.01; 95% CI: 0.00-0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38-178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01-0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0-62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1-44.8) are associated with satisfaction. CONCLUSION Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction. LEVEL OF EVIDENCE 3.
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An Evaluation of a Clinical Care Pathway for the Management of Men With Nonorganic Erectile Dysfunction. J Sex Med 2019; 16:1541-1546. [PMID: 31444103 DOI: 10.1016/j.jsxm.2019.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 07/07/2019] [Accepted: 07/14/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There exists little literature on the outcomes of the medical management of men with erectile dysfunction (ED) with no overt organic etiology. AIM This study was conducted to assess the outcomes of men with nonorganic ED treated medically. METHODS All patients had normal hormone profiles and vascular assessment. All were given a trial of a phosphodiesterase type 5 inhibitor (PDE5i). If no improvement was experienced, intracavernosal injection (ICI) therapy was administered. All patients were encouraged to seek a consultation with a mental health professional. MAIN OUTCOME MEASURE Patient demographics, medical comorbidities, hormone and hemodynamics assessments, and change in International Index of Erectile Function scores of patients were recorded. RESULTS 116 men with a mean age or 38 ± 19 (range 16-57) years were studied. 21% had mild ED, 47% had moderate ED, and 32% had severe ED. 21% had seen a psychiatrist. 81% of patients responded to PDE5i with a penetration hardness erection on follow-up (mean duration of 7 ± 3 months postcommencement of PDE5i). However, only 68% of these were capable of a consistently good response. The mean Erectile Function domain score on PDE5i for the entire group improved from 18 ± 11 to 22 ± 6 (P = .01), and for PDE5i responders it was 27 ± 4 (P < .001). 28% of men (22 PDE5i failures and 10 with a mixed response to PDE5i) attempted ICI, all obtaining consistently functional erections. At a mean time point of 11 ± 5 months, 83% of those responding to PDE5i had ceased using PDE5i due to a lack of need. 11% of those using ICI continued to use them 6 months after starting ICI; the remainder had been transitioned back to PDE5i. Of the 29 patients in the latter subgroup, 66% were no longer using PDE5i consistently due to a lack of need. CLINICAL IMPLICATIONS Not all men with nonorganic ED respond to PDE5i initially and many of those who respond do so only intermittently; such patients are potentially curable, using erectogenic pharmacotherapy for erectile confidence restoration, most men are capable of being weaned from drug therapy. STRENGTHS & LIMITATIONS The strengths of the study are the large number of patients and the use of serial validated instruments to assess erectile function outcomes. As a weakness, despite normal hormone and vascular assessments, the diagnosis of nonorganic ED is still a presumptive one. CONCLUSION Medical management of nonorganic ED utilizing the process of care model results in cure in a large proportion of such patients. The transient use of ICI in some patients permits successful PDE5i rechallenge. Jenkins LC, Hall M, Deveci S, et al. An Evaluation of a Clinical Care Pathway for the Management of Men With Nonorganic Erectile Dysfunction. J Sex Med 2019;16:1541-1546.
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A randomized double-blind, placebo-controlled, cross-over trial assessing the effect of tadalafil (Cialis) on the cardiovascular response in men with complete spinal cord injury above the sixth thoracic level: A Pilot Study. Spinal Cord Ser Cases 2018; 4:105. [PMID: 30479838 PMCID: PMC6249218 DOI: 10.1038/s41394-018-0137-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/09/2018] [Accepted: 11/01/2018] [Indexed: 12/02/2022] Open
Abstract
Study design Double-blind, randomized cross-over placebo-controlled pilot study. Objectives To determine the effects of tadalafil on systolic blood pressure (SBP), heart rate (HR), and dizziness of men with American Spinal Injury Association Impairment Scale-A (AIS-A) spinal cord injury (SCI) between cervical-4 (C4) and thoracic-5 (T5) levels. Setting Outpatient rehabilitation clinic. Design Double-blind, randomized cross-over placebo-controlled pilot study. Methods 20 males with AIS-A SCI, C4-T5 received either tadalafil 20 mg or placebo for the first arm, and then were crossed-over after 1 week to the second arm. SBP, HR, and Visual Analogue Scale (VAS) for dizziness upon sitting up from lying were measured at baseline and again 1, 2, 4, 12, 22, 29, and 36 h post dose administration. The change in each outcome measure (SBP, HR, VAS dizziness) was observed from pre-dose to each time point. A change in VAS dizziness of 2 cm or greater (scale 0–10 cm) was considered positive. Results SBP did not change significantly in either group. However, HR increased significantly in the tadalafil group at several time points (12 h p < 0.05, 22 h p <0.05, 29 h p <0.01, and 36 h p <0.05), with no change in the placebo group. The VAS dizziness significantly increased (range 2–6 cm changes) at some time point in 1/4 of the subjects after tadalafil, but not in the placebo group; all reports of dizziness were at 12 h or later. Conclusions Tadalafil use in people with SCI above T6 is safe with respect to not causing hypotension; hemodynamic changes that occurred 12–36 h post administration were compensated for by elevations in HR. Sponsorship The Manitoba Medical Services Foundation and the Health Sciences Centre Foundation.
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Soler JM, Navaux MA, Previnaire JG. Positive sexuality in men with spinal cord injury. Spinal Cord 2018; 56:1199-1206. [PMID: 29967449 DOI: 10.1038/s41393-018-0177-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective study. OBJECTIVES To analyze determinants of sexual pleasure in men with spinal cord injury (SCI). SETTING Centre Bouffard-Vercelli, Cerbere, France. METHODS Face to face interviews with men with chronic SCI who had an active sex life with a female partner, reliable erections permitting intercourse, and sought regular counselling with a sex therapist. Questionnaires: the International Index of Erectile Function (IIEF) and a modified Sexual History Form. RESULTS Thirty-three men were enroled. IIEF subscores were high for erectile function (mean 27.6/30), sexual desire (mean 8.8/10), intercourse satisfaction (mean 11.9/15) and overall satisfaction (mean 8.7/10). Overall satisfaction was significantly related to the level (p < 0.01) but not the severity of the lesion (p = 0.59), positively correlated with intercourse satisfaction (p < 0.001), negatively with age (p < 0.05) and age at injury (p < 0.01), but not with time since injury (p = 0.80). Orgasm was reported by 14 men (42%), and correlated strongly with antegrade ejaculation (p < 0.001), but not with overall satisfaction (p = 0.81). All men, except one, described enjoyable, long foreplay. Intercourse was associated with sensations of pleasure for 30 men (90%). After intercourse, 26 men (78%) experienced sensations of fulfilment, and 30 (90%) of relaxation. Most men expressed frustration, primarily in the case of absent or intermittent ejaculation or orgasm. Men described their female partners as taking more initiatives, and having a satisfactory sex life. CONCLUSIONS A positive and satisfying sex life is achievable by the men's willingness to adapt their sexual behaviour coupled with the reward of physical pleasure experienced during intercourse.
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Xybilun ® , actualité 2018 de la dysfonction érectile. SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gomes CM, Miranda EP, de Bessa J, Bellucci CHS, Battistella LR, Abdo CHN, Bruschini H, Srougi M, Mulhall JP. Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury. Sex Med 2017; 5:e148-e155. [PMID: 28823312 PMCID: PMC5562491 DOI: 10.1016/j.esxm.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/07/2017] [Accepted: 06/11/2017] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is usually a sudden traumatic event and has a negative effect on sexual function. AIM To evaluate the characteristics of sexual activity in men with SCI and identify predictors of being sexually active and having a satisfactory sex life. METHODS We assessed sexual activity profiles of men with SCI from a Brazilian tertiary rehabilitation center from February to August 2012. All patients older than 18 years with SCI for longer than 1 year were invited to participate. We analyzed age, time since SCI, patient age at SCI, employment status, partner status, completeness of lesion, functional independence, urinary continence, and Sexual Health Inventory for Men (SHIM) score. MAIN OUTCOME MEASURES The SHIM was used to assess erectile function (EF). Satisfaction with sex life was analyzed as a dichotomous variable. Predictors of an active and satisfactory sex life were identified using univariable and multivariable analyses. RESULTS We evaluated 295 men with mean age of 40.7 ± 14.5 years. Most patients had a complete SCI (65.1%) and 159 (53.9%) were incontinent. The median SHIM score was 5 (interquartile range = 0-16) and only 71 men (24.1%) had a SHIM score of at least 17. Of these men, 159 (53.9%) were sexually active. Only 63 men (39.6%) were satisfied with their sex life after SCI. In univariable analysis, all variables were associated with an active sex life. Those with a SHIM score of at least 17 had a greater likelihood of being sexually active (odds ratio = 116, 95% confidence interval = 14-432). EF was the only parameter associated with a satisfactory sex life (odds ratio = 1.3, 95% confidence interval = 1.2-1.4). CONCLUSIONS Most men with SCI were sexually inactive and/or dissatisfied with their sex life. Age, duration of SCI, completeness of SCI, continence, having a partner, and good EF were identified as predictors of an active sex life. However, only EF was a predictor of a satisfactory sex life. Gomes CM, Miranda EP, de Bessa J, et al. Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury. Sex Med 2017;5:e148-e155.
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Affiliation(s)
- Cristiano M Gomes
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil.
| | - Eduardo P Miranda
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil; Sexual and Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - José de Bessa
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | | | - Linamara Rizzo Battistella
- Institute of Physical Medicine and Rehabilitation, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | | | - Homero Bruschini
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - Miguel Srougi
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - John P Mulhall
- Sexual and Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Scaglione F, Donde S, Hassan TA, Jannini EA. Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction: Pharmacology and Clinical Impact of the Sildenafil Citrate Orodispersible Tablet Formulation. Clin Ther 2017; 39:370-377. [DOI: 10.1016/j.clinthera.2017.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 11/25/2022]
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Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2016; 13:465-88. [DOI: 10.1016/j.jsxm.2016.01.016] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 02/06/2023]
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Shridharani AN, Brant WO. The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol 2016; 5:88-101. [PMID: 26904415 PMCID: PMC4739980 DOI: 10.3978/j.issn.2223-4683.2016.01.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Erectile dysfunction (ED) related to compromise of the nervous system is an increasingly common occurrence. This may be due to the multifactorial nature of ED, the myriad of disorders affecting the neurotransmission of erectogenic signals, and improved awareness and diagnosis of ED. Nevertheless, neurogenic ED remains poorly understood and characterized. Disease related factors such as depression, decreased physical and mental function, the burden of chronic illness, and loss of independence may preclude sexual intimacy and lead to ED as well. The amount of data regarding treatment options in subpopulations of differing neurologic disorders remains scarce except for men with spinal cord injury. The treatment options including phosphodiesterase inhibitors, intracavernosal or intraurethral vasoactive agents, vacuum erection devices (VED) and penile prosthetic implantation remain constant. This review discusses the options in specific neurologic conditions, and briefly provides insight into new and future developments that may reshape the management of neurogenic ED.
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Affiliation(s)
- Anand N Shridharani
- 1 Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA ; 2 Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - William O Brant
- 1 Department of Urology, University of Tennessee College of Medicine, Chattanooga, TN, USA ; 2 Division of Urology, University of Utah, Salt Lake City, Utah, USA
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Courtois F, Charvier K. Sexual dysfunction in patients with spinal cord lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:225-45. [PMID: 26003247 DOI: 10.1016/b978-0-444-63247-0.00013-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many aspects of sexuality can be disrupted following a spinal cord lesion (SCL). It can alter an individual's self-esteem and body image, interfere with positioning and mobility, introduce unexpected problems with incontinence and spasticity, decrease pleasure, and delay orgasm. Sexual concerns in men can involve erectile function, essential for intercourse, ejaculation function, necessary for fertility, and the ability to reach orgasm. In women they can involve concerns with vaginal lubrication, genital congestion, and vaginal infections, which can all go unnoticed, and orgasm, which may be lost. All of these concerns must be addressed during rehabilitation as individuals with SCL continue to live an active sexual life, and consider sexuality among their top priority for quality of life. This chapter describes the impact of SCL on various phases of men's and women's sexual responses and on various aspects of sexuality. Treatments are described in terms of what is currently available and what is specific to the SCL population. New approaches in particular for women are described, along with tips from sexual counseling which consider an overall approach, taking into account the primary, secondary, and tertiary consequences of the SCL on the individual's sexuality. Throughout the chapter, attempts are made to integrate neurophysiologic knowledge, findings from the literature on SCL, and clinical experience in sexual rehabilitation.
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Affiliation(s)
- Frédérique Courtois
- Department of Sexology, Université du Québec à Montréal, Montreal, Quebec, Canada.
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Whitehurst DGT, Engel L, Bryan S. Short Form health surveys and related variants in spinal cord injury research: a systematic review. J Spinal Cord Med 2014; 37:128-38. [PMID: 24559417 PMCID: PMC4066421 DOI: 10.1179/2045772313y.0000000159] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT 'Short Form' health surveys - such as the SF-36 and SF-12 - are widely used in medical research. Spinal cord injury (SCI) is no exception, despite oft-cited concerns regarding measurement properties for populations with physical impairment. OBJECTIVE To provide a comprehensive overview of the use of Short Form health surveys and their variants within the SCI literature. METHODS Papers published between database inception and September 2012 were identified from 11 electronic databases; a supplementary reference list search was also conducted. Data extraction focused on details regarding the range of different Short Form surveys and variants used in SCI research, the respective frequency of use, the nature of reporting (complete versus partial reporting) and the method of survey administration. RESULTS One hundred seventy-four papers were identified. Thirty-six-item Short Form health surveys were frequently administered as complete instruments (n = 82); in 69 of these 82 studies (84%), it was not clearly stated which 36-item version had been used (e.g. SF-36v1, SF-36v2, RAND-36). Data for individual items and domains were often reported (29% of identified studies), indicating significant partial use of standardized measures. Modified variants of standardized health surveys were administered in 12 studies. CONCLUSION Although standardized Short Form health surveys are common within SCI research, attempts to add, delete, or modify items have resulted in a number of variants, often with minimal supportive psychometric evidence. Using established, generic outcome measures is appealing for a number of reasons. However, validity is paramount and requires further explicit consideration within the SCI research community.
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Affiliation(s)
- David G. T. Whitehurst
- Correspondence to: David G. T. Whitehurst, Faculty of Health Sciences, Blusson Hall 10504, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
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Ji YS, Choi JW, Ko YH, Song PH, Jung HC, Moon KH. How Serious Is Erectile Dysfunction in Men's Lives? Comparative Data From Korean Adults. Korean J Urol 2013; 54:467-71. [PMID: 23878690 PMCID: PMC3715711 DOI: 10.4111/kju.2013.54.7.467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/28/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose Whereas sexual function has long been assumed to be an important component of adult men's lives, the impact of sexual dysfunction has not been estimated in parallel to other modern disease entities. We compared the seriousness of erectile dysfunction (ED) with that of other diseases by use of self-administered questionnaires. Materials and Methods Between January 2012 and July 2012, 434 healthy male volunteers (group 1) and 263 ED patients (group 2) were enrolled. The questionnaire consisted of the following: "If you must undergo only one disease in all your life, which disease could you select among these items or ED?" The comparative disease entities included hypertension, diabetes mellitus (oral hypoglycemic agent/insulin injection), hemodialysis, myocardial infarction, herpes zoster, chronic sinusitis, chronic otitis media, gastric cancer (early/late), lung cancer (early/late), liver cancer (early/late), and dementia. Results Group 1 recognized ED as being a more serious disease than hypertension, diabetes mellitus (oral hypoglycemic agent), herpes zoster, chronic sinusitis, and chronic otitis media. In comparison, group 2 recognized ED as being a more serious condition than diabetes mellitus (insulin injection) and dementia (p<0.001 and p<0.001, respectively). In particular, ED was deemed to be more serious than hemodialysis, gastric cancer (early), lung cancer (early), and liver cancer (early) by men in group 2 in their 30s to 40s, and these results were statistically significant compared with the same age subgroups in group 1 (p<0.001, p<0.007, p<0.02, and p<0.007, respectively). Conclusions In contrast with their healthy counterparts, Korean men with ED recognized ED as being as serious as hemodialysis, dementia, and early stage cancer, which reflects the severe bother of ED in Korean patients.
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Affiliation(s)
- Yoon Seob Ji
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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Sawin KJ, Buran CF, Brei TJ, Fastenau PS. Sexuality issues in adolescents with a chronic neurological condition. J Perinat Educ 2012; 11:22-34. [PMID: 17273283 PMCID: PMC1595090 DOI: 10.1624/105812402x88579] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Substantial progress in the medical treatment of individuals with spina bifida (SB) has increased the numbers who survive into adolescence and adulthood. However, sexual health in this population has not received much attention. This study explored the knowledge (SB Sexuality Knowledge Scale), worries (SB Worries Scale), romantic appeal (from Harter's Self-Perception Scale), and access to sexuality information of a sample of 60 adolescents from a midwestern state. Study participants reported having sexual feelings like their peers, and they knew they could contract sexually transmitted diseases (STDs) if they were sexually active. However, only a moderate percentage was aware that women with SB are fertile, that adolescent women with SB should take a multivitamin with folic acid, and that latex-free condoms should be used by most adolescents with SB. They did not worry about their ability to make friends; however, these adolescents reported low levels of perceived romantic appeal and they worried about sexuality issues. These sexuality issues were not correlated to measures of SB neurological severity. Although over 50% reported having discussed sexuality with a health professional, 29% reported no one discussed sexuality and SB with them. Data from this study can affect the way health care providers and educators conduct sexuality education in health care and school settings.
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Affiliation(s)
- Kathleen J Sawin
- K athleen S awin is an associate professor in the School of Nursing at Virginia Commonwealth University in Richmond, Virginia. She is also a PNP in the Spina Bifida Program at the Children's Hospital in Richmond, Virginia
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Rizio N, Tran C, Sorenson M. Efficacy and satisfaction rates of oral PDE5is in the treatment of erectile dysfunction secondary to spinal cord injury: a review of literature. J Spinal Cord Med 2012; 35:219-28. [PMID: 22925748 PMCID: PMC3425878 DOI: 10.1179/2045772312y.0000000004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONCEPT Decreased sexual function is a major concern of men with spinal cord injuries (SCIs). Treatment of erectile dysfunction (ED) through oral pharmacotherapies has been proven to be an effective way to address and treat this concern. OBJECTIVE To find an efficacious and satisfactory treatment ED secondary to SCI through the compilation of studies that utilized the International Index of Erectile Function (IIEF) when testing phosphodiesterase V inhibitors (PDE5i). METHOD Ten articles, which used the IIEF to study satisfaction and/or efficacy of PDE5is sildenafil, tadalafil, and vardenafil in the treatment of ED were reviewed and analyzed. Through the use of a self-made grading scale the value of each article was determined for this research. RESULTS Sildenafil, tadalafil, and vardenafil all have been proven to be effective in treating ED in men with SCI. While sildenafil is the most thoroughly studied ED treatment for patients with SCI, tadalafil has a longer time duration effectiveness, which allows for more spontaneity in the sexual experience. Minimal adverse effects have been noted in patients with SCI using these medications; headache, flushing, and mild hypotension are the most common. In articles that study satisfaction, patients show great improvement over baseline with the use of these medications. CONCLUSION Although there is a need for further research on the safety in long-term use of tadalafil and vardenafil, comparative studies done on all three medications show no statistically significant difference in effectiveness or satisfaction. New medications and treatment options, such as avanafil, are being studied in hope of continued improvement of sexual function in men with SCI.
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Affiliation(s)
- Nicole Rizio
- Northwestern Memorial Hospital, Chicago, IL, USA.
| | - Claire Tran
- Northwestern Memorial Hospital, Chicago, IL, USA; and DePaul University Department of Nursing, Chicago, IL, USA
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Lombardi G, Nelli F, Celso M, Mencarini M, Del Popolo G. Treating Erectile Dysfunction and Central Neurological Diseases with Oral Phosphodiesterase Type 5 Inhibitors. Review of the Literature. J Sex Med 2012; 9:970-85. [DOI: 10.1111/j.1743-6109.2011.02615.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barbonetti A, Cavallo F, Felzani G, Francavilla S, Francavilla F. Erectile dysfunction is the main determinant of psychological distress in men with spinal cord injury. J Sex Med 2011; 9:830-6. [PMID: 22188659 DOI: 10.1111/j.1743-6109.2011.02599.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The weight of erectile dysfunction (ED) among the various determinants of psychological distress in men with spinal cord injury (SCI) remains to be clarified. AIM The aim of this article was to evaluate psychological distress features in SCI men with or without ED. METHODS Forty consecutive patients with neurologically stable SCI were included in the study. Functional independence (FI) was assessed by Barthel Index (BI), which was divided into global score (questions 1-10) and bowel/bladder subscore (questions 5 and 6). Erectile function was evaluated with Sexual Health Inventory for Men (SHIM). MAIN OUTCOME MEASURES Psychological distress was assessed with the Symptom Checklist-90-revised (SCL-90-R), scoring nine primary dimensions and their combination as Global Severity Index, a global index of psychological distress. RESULTS All SCL-90-R scores and the percentage of patients with scores >75th percentile of the entire study population were significantly higher in the group with ED (N=21) than without ED (N=19). Most of SCL-90-R subscales were inversely correlated with SHIM score. ED was exhibited by a high proportion (84%) of men with thoracolumbar lesions but by no patients with cervical lesions. Men with cervical lesions exhibited significantly lower SCL-90-R scores than those with thoracolumbar lesions, in spite of lower FI. However, the thoracolumbar group also reported a more severe bowel/bladder dysfunction. At multivariate logistic regression analysis, ED score significantly explained the variance of most of SCL-90-R dimension scores, whereas no association was revealed between global BI and any score of SCL-90-R dimensions. Bowel/bladder BI explained only to a very low extent the variance of depressive symptoms. CONCLUSIONS Healthcare providers should be aware of the importance of managing ED in spinal cord-injured men, as it represents a major determinant of their psychological distress, independently of the degree of FI impairment.
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Affiliation(s)
- Arcangelo Barbonetti
- Andrologic Unit, Department of Internal Medicine, University of L'Aquila, L'Aquila, Italy
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Manou BK, van Tam PN, Sesay M, Joseph P, Alloh DA, Bombo J, Kouakou J, Nandjui BM. Effect of sildenafil on erectile dysfunction in spinal cord injured patients. Ghana Med J 2011; 43:132-4. [PMID: 20126326 DOI: 10.4314/gmj.v43i3.55339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Erectile dysfunction is a preoccupying issue, just like motor and bladder disability, in spinal cord injured (SCI) patients. This is particularly so because of the increasing prevalence of paraplegic and tetraplegic subjects and the fact that these patients are younger, and sexually active. OBJECTIVE To determine the effects of Sildenafil (Viagra((R))) on erectile dysfunction in SCI patients. METHODS After medical ethics committee approval and informed patient consent, we conducted a prospective inquiry between January and March 2007 in 16 SCI patients who were under Sildenafil treatment for erectile dysfunction. An abridged version of the International Index of Erectile Function (IIEF-5) questionnaire was completed the patients. RESULTS The mean age (range) of the patients was 32.75 yrs (21-53 yrs). The mean duration of their disability was 47.75 months (4 yr). Trauma was the etiology in 87.5% of the cases (44% were road accidents). 12/16 patients were paraplegics (10 above T10) and 4 were tetraplegics (1 above C4 and 3 below C5). The mean duration of sildenafil treatment was 18.75 months (17 days-7 yr). 70% of the patients were satisfied with their erection after treatment. However, 10/16 patients had concomitant treatment with alprostadil. CONCLUSION Sildenafil is a vasoactive drug which can be used as a simple, discrete and effective treatment for erectile dysfunction in SCI patients. This approach is compatible with the efforts to improve the quality of life and rehabilitation of these patients.
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Affiliation(s)
- B K Manou
- Department of the nervous system and rehabilitation, faculty of medicine, university of Cocody, Abidjan
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Abstract
STUDY DESIGN Double-blind, placebo-controlled, flexible-dose study. OBJECTIVE To evaluate the efficacy, safety and tolerability of oral sildenafil in women with female sexual arousal disorder as a result of SCI (paraplegia/tetraplegia). SETTING The study was conducted at clinical practice sites in North America (n =23), 11 European countries (n =23), Australia (n =4) and South Africa (n =2). METHODS 129 women were randomized and treated with sildenafil or matching placebo. A 4-week baseline period was followed by 12 weeks of treatment, which could be increased from 50 to 100 mg or decreased to 25 mg once during the treatment period, depending on efficacy and tolerability. By use of an event log, sexual activity was monitored between screening and the end of treatment. The Sexual Function Questionnaire, the Sexual Quality of Life Questionnaire-Female, a global efficacy question and Sexual Distress Question were also assessed. RESULTS Sildenafil-treated women and placebo-treated women had an increase in their percentage of sexual activities throughout the course of the study, with no statistically significant difference between groups in the percentage of successful sexual activities at end of treatment versus baseline. There were also no statistically significant differences between sildenafil- and placebo-treated women on the aforementioned measures. The most common adverse events included headache and vasodilatation. CONCLUSION The results of this study are similar to other reports regarding a lack of clinically meaningful benefit of sildenafil in other populations of women. SPONSORSHIP This study was sponsored by Pfizer Inc.
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Eardley I, Donatucci C, Corbin J, El-Meliegy A, Hatzimouratidis K, McVary K, Munarriz R, Lee SW. Pharmacotherapy for Erectile Dysfunction. J Sex Med 2010; 7:524-40. [DOI: 10.1111/j.1743-6109.2009.01627.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lombardi G, Macchiarella A, Cecconi F, Del Popolo G. Ten‐Year Follow‐Up of Sildenafil Use in Spinal Cord‐Injured Patients with Erectile Dysfunction. J Sex Med 2009; 6:3449-57. [DOI: 10.1111/j.1743-6109.2009.01426.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alexander MS, Brackett NL, Bodner D, Elliott S, Jackson A, Sonksen J. Measurement of sexual functioning after spinal cord injury: preferred instruments. J Spinal Cord Med 2009; 32:226-36. [PMID: 19810624 PMCID: PMC2718820 DOI: 10.1080/10790268.2009.11760777] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE To determine the utility of certain instruments to assess sexuality and fertility after SCI, an expert panel identified key areas to study and evaluated available instruments. These were rated according to certain predefined criteria. METHODS The authors divided sexual issues into male and female sexual function, male reproductive function, and female reproductive function. The instruments that have been used most frequently to measure these aspects of sexual function over the past 5 years were identified by expert consensus. Finally, these instruments were subjected to a critical review. RESULTS The Female Sexual Function Index (FSFI), measurement of vaginal pulse amplitude (VPA), the International Index of Erectile Function (IIEF), and the measurement of ejaculatory function and semen quality were considered appropriate measures to assess sexual responses and reproductive function after SCI. There were no measures identified to assess female reproductive function. CONCLUSIONS For clinical trials aiming to improve sexual function after SCI, the FSFI or the IIEF is currently preferred. Although VPA is an appropriate means to assess female sexual responses, it is only useful for laboratory studies and is too invasive for use in clinical trials. For assessment of male fertility potential, assessment of ejaculatory capacity and semen analysis are recommended.
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Affiliation(s)
- Marcalee Sipski Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35242, USA.
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Ponizovsky AM, Averbuch L, Radomislensky I, Grinshpoon A. A multicenter, randomized, open-labeled, parallel group trial of sildenafil in alcohol-associated erectile dysfunction: the impact on psychosocial outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2510-25. [PMID: 19826560 PMCID: PMC2760426 DOI: 10.3390/ijerph6092510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 09/22/2009] [Indexed: 11/17/2022]
Abstract
To examine the effect of sildenafil on erectile dysfunction (ED) and psychosocial outcomes in alcohol-dependent (AD) men, 108 men with these diagnoses were randomly assigned to either take sildenafil (50 mg) as add-on to standard treatment for AD, or the same treatment without sildenafil, for 12 weeks. Only 50 patients in sildenafil group and 51 in control group twice completed the International Index of Erectile Function (IIEF) and a battery of self-report questionnaires. IIEF scores and psychosocial functioning, self-esteem and support from friends improved only for sildenafil-treated patients (P < 0.001). The high effect sizes suggest that the observed benefits are unlikely to be a placebo effect, although their unspecific nature could not be ruled out. In men with ED associated with AD, sildenafil improves both ED and psychosocial outcomes. Further placebo-controlled clinical trial is warranted.
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Affiliation(s)
- Alexander M. Ponizovsky
- Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem 93591, Israel; E-Mail:
| | - Lev Averbuch
- The Department of Substance Dependence Treatment, Ministry of Health, 20 King David St., Jerusalem 91010, Israel; E-Mail:
| | - Ira Radomislensky
- Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem 93591, Israel; E-Mail:
| | - Alexander Grinshpoon
- Tirat Carmel Mental Health Center, Ministry of Health, 17 Ha’ela St., ‘Tirat Carmel 30200, Israel Sha’ar Menashe Mental Health Center, Ministry of Health, Mobile Post Hefer 37806, Israel; E-Mail:
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Safarinejad MR, Kolahi AA, Ghaedi G. Safety and efficacy of sildenafil citrate in treating erectile dysfunction in patients with combat-related post-traumatic stress disorder: a double-blind, randomized and placebo-controlled study. BJU Int 2009; 104:376-83. [PMID: 19389004 DOI: 10.1111/j.1464-410x.2009.08560.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of sildenafil citrate for treating erectile dysfunction (ED) in patients with combat-related post-traumatic stress disorder (PTSD). PATIENTS AND METHODS In all, 266 combat-exposed war veterans with ED (aged 37-59 years) were recruited. They met the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for PTSD according to the Structured Clinical Interview for Patients, Investigator Version. The patients were also evaluated with the Clinician-Administered PTSD Scale, both to establish the diagnosis of PTSD and to measure symptom severity. Only patients with psychogenic ED were included in the study. Patients with comorbid conditions (diabetes mellitus, hypercholesterolaemia, hypertension, Peyronie's disease) and smokers of more than five cigarettes daily were excluded. The patients were randomly divided into a group of 133 who received 100 mg of on-demand sildenafil 0.75-2 h before sexual stimulation, and 133 who received placebo. Patients were asked to use > or =16 doses or attempts at home. The efficacy of the treatments was assessed every four attempts during treatment, and at the end of the study, using responses to the 15-question International Index of Erectile Function (IIEF), Sexual Encounter Profile diary questions 2 and 3, Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, patients' event logs of sexual activity, and a Global Assessment Question about erections. RESULTS Sildenafil did not produce significantly and substantially greater improvement than placebo in each of the primary and secondary outcome measures (P = 0.08). A normal EF domain score (> or =26) at endpoint was reported by 13 (9.8%), and 11 (8.3%) of patients on the sildenafil and placebo regimens, respectively (P = 0.09). Patients treated with sildenafil had no statistically significantly greater improvement in the five sexual function domains of the IIEF questionnaire than those treated with placebo (P = 0.08). The incidences of treatment-emergent adverse events were significantly greater in the sildenafil arm than in the placebo group (P = 0.01). CONCLUSIONS Sildenafil is no better than placebo in treating PTSD-emergent ED. Further randomized clinical trials are warranted in combat veterans and other populations with PTSD to better elucidate the role of phosphodiesterase type 5 inhibitors in treating PTSD-emergent ED.
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Lombardi G, Macchiarella A, Cecconi F, Del Popolo G. Ten years of phosphodiesterase type 5 inhibitors in spinal cord injured patients. J Sex Med 2009; 6:1248-58. [PMID: 19210710 DOI: 10.1111/j.1743-6109.2008.01205.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The majority of men with spinal cord injury (SCI) require chronic treatment for erectile dysfunction (ED), but most of them, prior to taking phosphodiesterase type 5 (PDE5) inhibitors, stopped therapy due to side-effects or low compliance rate. AIM Analysis of literature on oral PDE5 inhibitors in individuals with SCI and ED in order to evaluate how much their release changed the management of ED in SCI subjects and what remains to be seen of their potential or limits. MAIN OUTCOME MEASURES Questionnaires on sexual function. METHODS 18 internationally published clinical studies that enrolled SCI males treated with at least one of the PDE5 inhibitors were analyzed. RESULTS The small numbers of papers with large and diverse outcome measures did not consent a meta-analysis of treatment results. 705 used sildenafil, 305 vardenafil and 224 tadalafil. Median age was less than 40 years. Only 1 study excluded tetraplegic individuals. For measures of ED evaluated, 11 out of 13 studies reported a significant statistical improvement with PDE5 inhibitors versus placebo or erectile baseline (P < 0.01, or p < 0.005). The most frequent predicable factor for the therapeutic success of PDE5 inhibitors was upper motoneuron lesion. Statistical impact on ejaculation success rates was shown in at least one paper for all PDE5 inhibitors (p < 0.05). Overall, 15 patients, (7 using sildenafil), discontinued the therapies due to drawbacks. Only 1 sildenafil study reported a follow-up maximum of 24 months. CONCLUSIONS Literature suggests that all oral PDE5 inhibitors represent a safe and effective treatment option for ED caused by SCI. Further research is needed on head-to-head comparative trials and SCI patient preference for these drugs; their impact on ejaculation and orgasm function, their early use after SCI for increasing the recovery rate of a spontaneous erection, and their effectiveness and tolerability in the long-term are still to be investigated.
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Affiliation(s)
- Giuseppe Lombardi
- Spinal Cord Department, Neurourology, Via Largo Palagi 1, 50139 Careggi University Hospital, Florence, Italy.
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The Effects of Sildenafil Citrate on Ischemic Colonic Anastomotic Healing in Rats: Its Relationship Between Nitric Oxide and Oxidative Stress. World J Surg 2008; 32:2107-13. [DOI: 10.1007/s00268-008-9661-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hatzimouratidis K. Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence. Clin Interv Aging 2008; 1:403-14. [PMID: 18046917 PMCID: PMC2699643 DOI: 10.2147/ciia.2006.1.4.403] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Erectile dysfunction (ED) is a highly prevalent disease associated with aging as well as with several risk factors including hypertension, heart disease, obesity, dyslipidemia, diabetes, hypogonadism, drugs-related, and pelvic surgery. Many of these factors are components of the metabolic syndrome, a multiplex risk factor for cardiovascular disease (CVD). ED shares common risk factors with CVD. Endothelial dysfunction seems to be the early underlying pathophysiology across both conditions. The efficacy, tolerability and cardiovascular safety of sildenafil has been evaluated in numerous large, randomized, double-blind, placebo-controlled clinical studies in the broad population of men with ED including men with several co-morbid conditions. Sildenafil is effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy. It is associated with rapid onset of action – within 14 minutes for some men – and an extended duration of action for up to 12 hours. Sildenafil improves quality of life and satisfaction for treated men and is well tolerated with a favorable safety profile. New data suggest that sildenafil has beneficial effects in several chronic conditions. It has been approved for the treatment of idiopathic pulmonary hypertension. Numerous articles have suggested that it improves endothelial function and a possible role on premature ejaculation or treatment of lower urinary tract symptoms has been suggested.
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Affiliation(s)
- Konstantinos Hatzimouratidis
- 2nd Department of Urology, Papageorgiou General Hospital, and Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Ergin S, Gunduz B, Ugurlu H, Sivrioglu K, Oncel S, Gok H, Erhan B, Levendoglu F, Senocak O. A placebo-controlled, multicenter, randomized, double-blind, flexible-dose, two-way crossover study to evaluate the efficacy and safety of sildenafil in men with traumatic spinal cord injury and erectile dysfunction. J Spinal Cord Med 2008; 31:522-31. [PMID: 19086709 PMCID: PMC2607124 DOI: 10.1080/10790268.2008.11753647] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects on quality of life (QoL) using the Life-Satisfaction Check List. METHODS This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI (Sexual Health Inventory-Male score < or =21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). RESULTS Compared with placebo, sildenafil produced higher levels of successful sexual stimulation, intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects on vital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient QoL. Sildenafil was well tolerated, with a profile comparable to that of placebo. CONCLUSIONS Compared with placebo, treatment with oral sildenafil safely and effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was the agent of choice in those who expressed a preference.
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Affiliation(s)
- Sureyya Ergin
- 1Department of Physical Medicine and Rehabilitation, Medical School of Ankara University, Ankara, Turkey
| | - Berrin Gunduz
- 2Ministry of Health 7a Yil Physical Health and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Hatice Ugurlu
- 3Department of Physical Medicine and Rehabilitation, Medical School, Selcuk University, Konya, Turkey
| | - Koncuy Sivrioglu
- 4Department of Physical Medicine and Rehabilitation, Medical School, Uludag University, Bursa, Turkey
| | - Sema Oncel
- 5Department of Physical Medicine and Rehabilitation, Medical School, Dokuz Eylūl University, Izmir, Turkey
| | - Haydar Gok
- 1Department of Physical Medicine and Rehabilitation, Medical School of Ankara University, Ankara, Turkey
| | - Belgin Erhan
- 2Ministry of Health 7a Yil Physical Health and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Funda Levendoglu
- 3Department of Physical Medicine and Rehabilitation, Medical School, Selcuk University, Konya, Turkey
| | - Ozlem Senocak
- 5Department of Physical Medicine and Rehabilitation, Medical School, Dokuz Eylūl University, Izmir, Turkey
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Sexual health outcome measures for individuals with a spinal cord injury: a systematic review. Spinal Cord 2007; 46:320-4. [PMID: 17938640 DOI: 10.1038/sj.sc.3102136] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A systematic review of all sexual health outcome measures reporting psychometric properties for a spinal cord injury (SCI) population. OBJECTIVES To evaluate the psychometric evidence for sexual health outcome measures used in a SCI population in order to (1) determine the clinical relevance of current tools and (2) suggest recommendations for future tool development. SETTING Vancouver, British Columbia, Canada. METHODS Electronic databases were searched for articles reporting psychometric properties of sexual health outcome measures used in a SCI population. The search was limited to papers published between January 1986 and January 2006. Hand-searching the references of papers obtained from the electronic search identified additional articles. RESULTS Four outcome measures met the search criteria: Emotional Quality of the Relationship Scale (EQR), Sexual Activity and Satisfaction Scale (SAS), Sexual Attitude and Information Questionnaire (SAIQ) and Sexual Interest and Satisfaction Scale (SIS). While the clinical utility of these tools may be compromised by their limited scope and advancing age, they may still prove useful for guiding SCI research and clinical practice. CONCLUSION There is no clinically agreed upon SCI measurement tool for sexual health outcomes. To adequately assess the complex issue of sexual health, it is recommended that future sexual health outcome measures include both quantitative and qualitative data as well as address several key issues.
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Mohamed A, Faddah LM. Therapeutic Effects of Sildenafil Citrate (Viagra) And/or Vitamin E on Some Brain Disorders of Alloxan Induced Diabetes Mellitus Rats. JOURNAL OF MEDICAL SCIENCES 2007. [DOI: 10.3923/jms.2007.932.941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL. Long-term effects of spinal cord injury on sexual function in men: implications for neuroplasticity. Spinal Cord 2006; 45:338-48. [PMID: 17016492 DOI: 10.1038/sj.sc.3101978] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Secure, web-based survey. OBJECTIVES Elicit specific information about sexual function from men with spinal cord injuries (SCI). SETTING World-wide web. METHODS Individuals 18 years or older living with SCI obtained a pass-code to enter a secure website and then answered survey questions. RESULTS The presence of genital sensation was positively correlated with the ability to feel a build up of sexual tension in the body during sexual stimulation and in the feeling that mental arousal translates to the genitals as physical sensation. There was an inverse relationship between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. A positive relationship existed between the occurrence of spasticity during sexual activity and erectile ability. Roughly 60% of the subjects had tried some type of erection enhancing method. Only 48% had successfully achieved ejaculation postinjury and the most commonly used methods were hand stimulation, sexual intercourse, and vibrostimulation. The most commonly cited reasons for trying to ejaculate were for pleasure and for sexual intimacy. Less than half reported having experienced orgasm postinjury and this was influenced by the length of time postinjury and sacral sparing. CONCLUSION SCI not only impairs male erectile function and ejaculatory ability, but also alters sexual arousal in a manner suggestive of neuroplasticity. More research needs to be pursued in a manner encompassing all aspects of sexual function.
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Affiliation(s)
- K D Anderson
- Department of Neurological Surgery, Reeve-Irvine Research Center, University of California, Irvine, CA 92697, USA
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Rosen RC, Althof SE, Giuliano F. Research instruments for the diagnosis and treatment of patients with erectile dysfunction. Urology 2006; 68:6-16. [PMID: 17011371 DOI: 10.1016/j.urology.2006.05.046] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 05/01/2006] [Accepted: 05/19/2006] [Indexed: 11/25/2022]
Abstract
As the incidence and prevalence of erectile dysfunction (ED) increase, healthcare providers will require robust, accurate, and efficient tools for appropriately diagnosing and treating patients with ED. Moreover, clinicians will need effective follow-up tools that assess treatment efficacy and satisfaction, to help patients meet their expectations for successful treatment of ED. We provide a summary of some of the most commonly used instruments for the diagnosis and assessment of ED treatment efficacy that will be referred to in this supplement.
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Affiliation(s)
- Raymond C Rosen
- Department of Psychiatry, Center for Sexual and Marital Health, Robert Wood Johnson Medical School, Piscataway, New Jersey 08854-5635, USA.
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Soler JM, Previnaire JG, Denys P, Chartier-Kastler E. Phosphodiesterase inhibitors in the treatment of erectile dysfunction in spinal cord-injured men. Spinal Cord 2006; 45:169-73. [PMID: 16801935 DOI: 10.1038/sj.sc.3101950] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Open, before-after study. OBJECTIVE To assess the efficacy and safety of phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction (ED) in spinal cord-injured (SCI) patients. SETTING Home- and clinic-based assessments in the outpatient department at the Centre Bouffard Vercelli, Cerbère France. METHODS Clinic trials with Sildenafil (Viagra) on 120 patients, Tadalafil (Cialis) on 54 patients and Vardenafil (Levitra) on 66 patients were performed. Flexible doses of PDE5 inhibitors were given depending on efficacy and tolerability, from 50 to 100 mg for Sildenafil, and from 10 to 20 mg for Vardenafil and Tadalafil. Each trial was performed after a week's interval. The efficacy was self-assessed by the patients on a six-point quantitative scale assessment. The response to treatment was assessed at home in 90 patients (57 patients on Sildenafil, 12 patients on Vardenafil and 21 patients on Tadalafil) using the International Index of Erectile Function (IIEF). RESULTS In clinic trials, PDE5 inhibitors were effective (rigidity enough for penetration) in 85% of the patients on Sildenafil, 74% of the patients on Vardenafil and 72% of the patients on Tadalafil. The mean duration of erection was 34, 28 and 26 min, respectively. Adverse effects were mild, usually attenuated with continued dosing. More than 70% of the patients on Vardenafil and Tadalafil required higher doses of 20 mg, whereas 50 mg of Sildenafil was effective in 55% of the patients. Two-thirds of our patients on Tadalafil reported a duration of action longer than 24 h. The presence of an upper motor neuron lesion was significantly associated with therapeutic success, lower motor neuron lesions and cauda equina patients were poor responders. Other variables such as completeness of lesion had no impact. In the follow-up visits, the IIEF global scores and three IIEF domains (erectile function, intercourse satisfaction and overall satisfaction) were significantly improved in all patients. Patients on Sildenafil showed a significant improvement of orgasmic function, ejaculation (Question 9) and orgasm (Question 10). CONCLUSION Sildenafil, Vardenafil and Tadalafil are all effective and well-tolerated treatments for ED in SCI patients. Although no statistical analysis could be applied on these data, these results might indicate that Sildenafil is more effective in treating ED. Clinic trials are important for proper dose titration and appropriate education of the patients.
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Affiliation(s)
- J M Soler
- Centre Bouffard Vercelli, Laboratoire d'urodynamique et de sexologie, Cerbère, France
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Mallis D, Moisidis K, Kirana PS, Papaharitou S, Simos G, Hatzichristou D. ORIGINAL RESEARCH—PSYCHOLOGY: Moderate and Severe Erectile Dysfunction Equally Affects Life Satisfaction. J Sex Med 2006; 3:442-9. [PMID: 16681469 DOI: 10.1111/j.1743-6109.2005.00173.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore the life satisfaction of patients with erectile dysfunction (ED) and to examine the relation between severity of ED and life satisfaction. MATERIALS AND METHODS The study sample was recruited from patients who presented in an andrologic outpatient clinic complaining of ED. All patients underwent the basic clinical evaluation and were assessed by the International Index of Erectile Dysfunction (IIEF) and the Life Satisfaction Inventory (LSI). RESULTS The study included 69 patients with ED (age range 22-71 years, mean 49.5, SD 13.7). The LSI appeared to have satisfactory internal consistency (Cronbach's alpha = 0.82). Men with ED had significantly lower satisfaction with their sexual life (t = -13.756, d.f. = 68, P = 0.000), but also significantly lower total score of satisfaction with their life (t = -2.793, d.f. = 68, P = 0.007) compared with available normative data from healthy population. However, when compared with controls, men with ED showed significantly higher satisfaction scores on their financial status (t = 5.075, d.f. = 68, P = 0.000) and on their leisure time activities (t = 4.029, d.f. = 68, P = 0.000). Regarding ED severity, mild ED affects patients' satisfaction with sexual life less than do moderate and severe ED. Interestingly, no difference was identified between moderate and severe ED groups. CONCLUSIONS Men who seek help for ED have lower satisfaction with sexual life and lower satisfaction with their overall life compared with healthy people. Severity of ED seems to be an important factor, as men with moderate ED perceive the impact of ED on their life satisfaction equally with those with severe ED. ED patients gain more satisfaction from other domains of their life, provided they adopt coping behaviors that help compensate for their low overall life satisfaction. Furthermore, as ED patients do not differ from healthy people in their expressed subjective rating of quality of life (QoL), life satisfaction may be more sensitive than QoL assessment in the evaluation of the impact of ED on our patients' life.
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Affiliation(s)
- Dimitrios Mallis
- Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Affiliation(s)
- Marca L Sipski
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA
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Use of Sildenafil in the Treatment of Erectile Dysfunction in Patients With Spinal Cord Injury. ACTA ACUST UNITED AC 2006. [DOI: 10.1097/01.wnq.0000190406.86285.da] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Deforge D, Blackmer J, Garritty C, Yazdi F, Cronin V, Barrowman N, Fang M, Mamaladze V, Zhang L, Sampson M, Moher D. Male erectile dysfunction following spinal cord injury: a systematic review. Spinal Cord 2005; 44:465-73. [PMID: 16317419 DOI: 10.1038/sj.sc.3101880] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To review sexuality in persons with spinal cord injuries (SCIs), and to report the effectiveness of erectile interventions. METHODS Reports from six databases (1966-2003), selected annual proceedings (1997-2002) and manufacturer's information were screened against eligibility criteria. Included reports were abstracted and data pooled from case-series reports regarding intracavernous injections and sildenafil. RESULTS From 2127 unique reports evaluated, 49 were included. Male sexual dysfunction was addressed in these reports of several interventions (behavioural therapy, topical agents, intraurethral alprosatadil, intracavernous injections, vacuum tumescence devices, penile implants, sacral stimulators and oral medication). Penile injections resulted in successful erectile function in 90% (95% CI: 83%, 97%) of men. Sildenafil resulted in 79% (95% CI: 68%, 90%) success; the difference in efficacy was not statistically significant. Five case-series reports involving 363 participants with penile implants demonstrated a high satisfaction rate, but a 10% complication rate. CONCLUSIONS A large body of evidence addressing sexuality in males focuses on erection. Penile injection, sildenafil and vacuum devices generally obviate the need for penile implants to address erectile dysfunction. Interventions may positively affect sexual activity in the short term. Long-term sexual adjustment and holistic approaches beyond erections remain to be studied. Rigorous study design and reporting, using common outcome measures, will facilitate higher quality research. This will positively impact patient care. SPONSORSHIP Agency for Healthcare Research and Quality, US Department of Health and Human Services, 2101 East Jefferson Street, Rockville, MD 20852, USA.
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Affiliation(s)
- D Deforge
- The Rehabilitation Centre, Ottawa Hospital, Ottawa, Ontario, Canada
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Cappelleri JC, Althof SE, Siegel RL, Stecher VJ, Tseng LJ, Duttagupta S. Association between the Erectile Dysfunction Inventory of Treatment Satisfaction and the Self-Esteem and Relationship Questionnaire following treatment with sildenafil citrate for men with erectile dysfunction. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2005; 8 Suppl 1:S54-60. [PMID: 16336489 DOI: 10.1111/j.1524-4733.2005.00072.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Research is lacking on the correlation between treatment satisfaction and confidence, self-esteem, and relationships for men receiving treatment for erectile dysfunction (ED). We sought to correlate scores between the validated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index and the validated Self-Esteem And Relationship (SEAR) questionnaire following treatment with sildenafil citrate (VIAGRA). METHODS This study was based on an open-label, flexible-dose trial of 93 sildenafil-naive patients with ED. Pearson correlation coefficients between EDITS index and SEAR questionnaire scores, each of which can range from 0 to 100 (most favorable), were calculated at end of treatment (EOT). An analysis of covariance model was applied to associate changes from baseline to EOT in SEAR scores with EDITS score at EOT, controlling for baseline SEAR score. RESULTS Significant and sizable Pearson's correlations between SEAR and EDITS scores (P < or = 0.0001; range: 0.49-0.84) were observed. A 10-point higher EDITS scores at EOT corresponded to a significant and tangible average improvement in SEAR scores from baseline to EOT (P < or = 0.0001; range: 6.6-8.7). Average SEAR scores at EOT were markedly different between patients with greater treatment satisfaction at EOT (EDITS score > or = median EDITS score of 88.6; n = 50) and those with lesser treatment satisfaction at EOT (EDITS score <88.6; n = 43). CONCLUSIONS The data add to the validity of the SEAR questionnaire, suggest a tangible relationship between treatment satisfaction and psychosocial benefit among men with ED treated with sildenafil, and highlight the importance of assessing the psychosocial impact of ED in men undergoing treatment.
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Dahlberg A, Alaranta H, Sintonen H. Health-related quality of life in persons with traumatic spinal cord lesion in Helsinki. J Rehabil Med 2005; 37:312-6. [PMID: 16203620 DOI: 10.1080/16501970510034413] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To estimate the health-related quality of life (HRQoL) of persons with spinal cord lesion. DESIGN The study design was cross-sectional. SUBJECTS All adult citizens in Helsinki with traumatic spinal cord lesion were identified. The final study group comprised 117 subjects, corresponding to a participation rate of 77%. METHODS HRQoL was assessed by a generic 15-dimensional self-administered instrument (15D). Clinical examination was based on the manual of the American Spinal Injury Association. Examinations were performed on all subjects by the same experienced physician and physiotherapist. RESULTS The average 15D score of the study group was significantly lower (p<0.001) than that measured in the age-matched general population sample. Subjects with spinal cord lesion had significantly more problems due to the neurological lesion but also on the dimensions of sleeping, discomfort and symptoms and vitality. In regression analysis of the study group the only variable explaining HRQoL was the neurological level of the lesion. Spinal cord lesion caused more depression and distress in persons with motor incomplete lesion than those with motor complete lesion. CONCLUSION Persons with spinal cord lesion had lower HRQoL than the population in general. The results indicate that spinal cord lesion may cause problems in the areas of sleeping, discomfort and symptoms or vitality, in particular. More attention should be paid to finding ways of improving the situation of persons with motor incomplete lesion, especially in terms of psychological function.
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Affiliation(s)
- Antti Dahlberg
- Käpylä Rehabilitation Centre, Finnish Association of People with Mobility Disabilities, Helsinki, Finland.
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Del Popolo G, Li Marzi V, Mondaini N, Lombardi G. Time/duration effectiveness of sildenafil versus tadalafil in the treatment of erectile dysfunction in male spinal cord-injured patients. Spinal Cord 2004; 42:643-8. [PMID: 15289800 DOI: 10.1038/sj.sc.3101617] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A randomized, blinded, crossover clinical trial comparing sildenafil versus tadalafil for erectile dysfunction (ED) in male spinal cord-injured (SCI) patients. OBJECTIVES To compare the safety, time/duration effectiveness, and the impact on the quality of life (QoL) of tadalafil 10 mg versus sildenafil 50 mg. SETTING Neurourology Section, Careggi Hospital, Florence, Italy. METHODS During a screening (visit 1), a diary card was distributed, in which the subjects assessed, after each attempt at intercourse the quality of their erection, responding (Yes/No) to both Sexual Encounter Profile Questions 2 (SEP2) and 3 (SEP3). The subjects made at least four attempts at intercourse. At visit 2, 15 patients (group 1) were assigned sildenafil and 15 (group 2) started with tadalafil. Responses to baseline International Index of Erectile Function 5 items (IIEF-5), Questions 13-14 (IIEF 15 items) and SEP diary were recorded. Patients attempted intercourse on four separate occasions: within 4 h of taking the first tablet, within 12 h for the second tablet, 24 h for the third, and the fourth from 24 to 36 h. At visit 3, the investigators evaluated the effectiveness with the same measures used at baseline. After a wash-out period, at visit 4, Group 1 was given tadalafil, and Group 2 was given sildenafil. Patients were required to observe the same criteria in taking the four tablets as in visit 2. After 4 weeks (visit 5), we evaluated the patients as we did in visit 3. RESULTS Overall, 28 patients completed the study. No subjects discontinued the drugs due to drawbacks. Tadalafil allowed a majority of men in this trial to achieve both normal sexual functioning up to 24 h postdosing compared to sildenafil (P<0.01) and improved overall sex life satisfaction as well as sexual relations with partner. CONCLUSION Based on these data, tadalafil may have the potential to become an important treatment option for ED in SCI patients. SPONSORSHIP This study was not sponsored.
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Affiliation(s)
- G Del Popolo
- 1Neurourology Section, Spinal Unit, Careggi Hospital, Florence, Italy
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Montorsi F, Hellstrom WJG, Valiquette L, Bastuba M, Collins O, Taylor T, Thibonnier M, Homering M, Eardley I. Vardenafil provides reliable efficacy over time in men with erectile dysfunction. Urology 2004; 64:1187-95. [PMID: 15596195 DOI: 10.1016/j.urology.2004.07.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Accepted: 07/27/2004] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the reliability of vardenafil efficacy and tolerability within 12 weeks in a broad population of men with erectile dysfunction (ED). METHODS In a retrospective analysis of two pivotal, Phase III, randomized, double-blind, placebo-controlled trials conducted in 107 centers, 1650 men aged 18 years or older with ED received vardenafil 5 mg, 10 mg, or 20 mg on demand for 12 to 26 weeks. Outcome measures included the first-time and subsequent overall success rate until week 12 for diary entries regarding vaginal penetration (Sexual Encounter Profile [SEP]-2), erection maintenance (SEP-3), satisfaction with erection hardness, and overall satisfaction with the sexual experience. Mean efficacy was calculated for each patient during 12 weeks and then averaged for all patients within each treatment group. RESULTS At baseline, the intention-to-treat population had moderate ED (International Index of Erectile Function-Erectile Function domain score of 13). For SEP-2 (penetration), the first-attempt and subsequent success rate was 44% and 74% for placebo, 71% and 81% for vardenafil 5 mg, 76% and 86% for vardenafil 10 mg, and 76% and 91% for vardenafil 20 mg, respectively. For SEP-3 (maintenance), first-attempt and subsequent success rate was 25% and 56% for placebo, 51% and 76% for vardenafil 5 mg, 65% and 76% for vardenafil 10 mg, and 59% and 84% for vardenafil 20 mg, respectively. For overall satisfaction with the sexual experience, the first-attempt and subsequent success rate was 19% and 48% for placebo, 48% and 68% for vardenafil 5 mg, 57% and 72% for vardenafil 10 mg, and 56% and 79% for vardenafil 20 mg, respectively. The reliability of vardenafil was similar or slightly greater in sildenafil-naive subjects compared with prior sildenafil responders. The most common adverse events were mild-to-moderate headache, flushing, and rhinitis. CONCLUSIONS Vardenafil provides reliable efficacy for key erectile function parameters important to patients when continuing oral treatment for ED.
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Abstract
Spinal cord injury is known to have a major impact on human sexual function. The disturbances depend on the level and completeness of the lesion. The majority of people affected by spinal cord injury are young and in their reproductive years. In these cases sexuality reflects an important aspect of personality, and therefore special attention needs to be given to this issue during rehabilitation. Sexual rehabilitation encompasses both comprehensive information and consultation as well as diagnosis and treatment of disturbed sexual functions. Successful rehabilitation and integration depend also on restoration of sexual function or adequate therapy of sexual dysfunction. This review will consider the present knowledge about the impact of spinal cord injury on female and male sexual function, the currently available treatment options as well as the aspects of fertility and reproduction in this patient population.
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Affiliation(s)
- A Reitz
- Neuro-Urologie, Schweizer Paraplegikerzentrum, Universitätsklinik Balgrist, Zürich.
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Abstract
Impairment of erectile function compromises quality of life in millions of men and their partners, many of whom prefer to suffer in silence. It is important to maintain an elevated index of clinical suspicion in patients with erectile dysfunction (ED) risk factors (e.g. hypertension, diabetes, coronary heart disease). There remains a high rate of voluntary discontinuation of therapy associated with most treatment modalities. Since the introduction of sildenafil, a greater awareness and openness regarding the epidemiology and treatment of male erectile dysfunction has emerged. The development of newer and potentially more efficacious phosphodiesterase type 5 (PDE5) inhibitors will serve to treat an even greater number of patients, allowing once daily and more convenient dosing. An increased understanding of the physiological principles of penile erection has allowed the development of novel oral pharmacological therapies. The new agents offer a potential benefit in a broader range of patients and clinical situations. They may provide a more acceptable alternative than other more invasive options (intracavernosal/urethral injection, implant surgery). The dopamine agonist apomorphine acts on the central control of penile erection to allow a sublingual preparation to produce a prompt response. It is not contraindicated in patients on nitrate medication for coronary artery disease, or in patients with depression or on antidepressants. As with any other treatment, the clinician's responsibility in the care of ED patients does not end with the writing of a prescription. Adequate education and follow-up are needed to optimize the efficacy and safety of oral ED therapy. Furthermore, patients and their partners need to be advised that the agents are not effective in the absence of sexual stimulation. Communicating with both the patient and his partner in a discreet, non-judgmental manner that fosters the physician-patient alliance can facilitate the recognition and treatment of ED.
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Affiliation(s)
- J S Kalsi
- The Wolfson Institute for Biomedical Research, The Cruciform Building, University College London, Gower Street, London WC1E 6BT, UK.
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Rosen RC, Seidman SN, Menza MA, Shabsigh R, Roose SP, Tseng LJ, Orazem J, Siegel RL. Quality of life, mood, and sexual function: a path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms. Int J Impot Res 2004; 16:334-40. [PMID: 14961048 DOI: 10.1038/sj.ijir.3901197] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Erectile dysfunction (ED) is commonly associated with depressed mood and diminished quality of life (QoL), but few studies have investigated the causal associations involved. Therefore, we evaluated the correlation between several measures of mood, QoL, and sexual function in a retrospective analysis of a sample of depressed men (n=152), with ED enrolled in a clinical trial of sildenafil citrate (VIAGRA). Strong correlations were observed at baseline among measures of erectile function (EF), mood, and overall QoL. Significant treatment effects were observed on all three domains, with significant interactions between changes in mood and QoL. Based on multiple regression and path analysis, a model was developed in which EF changes were associated with improved mood and quality of sexual life, which resulted in improved partner satisfaction, family life, and overall life satisfaction. These data suggest that QoL changes associated with ED therapy may be mediated by changes in sexual function, mood, and family relationships.
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Affiliation(s)
- R C Rosen
- University of Medicine and Dentistry, Robert Wood Johnson Medical School, Piscataway, New Jersey 08554-5653, USA.
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Cappelleri JC, Althof SE, Siegel RL, Shpilsky A, Bell SS, Duttagupta S. Development and validation of the Self-Esteem And Relationship (SEAR) questionnaire in erectile dysfunction. Int J Impot Res 2004; 16:30-8. [PMID: 14963468 DOI: 10.1038/sj.ijir.3901095] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Development and validation of a patient-reported measure of psychosocial variables in men with erectile dysfunction (ED) is described. Literature review, focus groups, and medical specialists identified 86 potential items. Redundant, ambiguous, or low item-to-total correlation items were removed. Data from 98 men reporting diagnosed ED and 94 controls assisted in final item selection and psychometric evaluation. Treatment responsiveness was evaluated in 93 men with ED in a 10-week open-label trial of sildenafil citrate (Viagra). The 14 chosen items resolved into two domains: Sexual Relationship (eight items) and Confidence (six items), the latter comprising Self-Esteem (four items) and Overall Relationship (two items) subscales. The resulting Self-Esteem And Relationship (SEAR) questionnaire demonstrated validity and reliability. The intervention study demonstrated responsiveness to beneficial treatment with significant improvement in scores (P=0.0001). The SEAR questionnaire possesses strong psychometric properties that support its validity and reliability for measuring sexual relationship, confidence, and particularly self-esteem.
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Affiliation(s)
- J C Cappelleri
- Pfizer Inc Global Research and Development, Groton, CT 06340, USA.
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Carson CC. Sildenafil: A 4-year update in the treatment of 20 million erectile dysfunction patients. Curr Urol Rep 2003; 4:488-96. [PMID: 14622503 DOI: 10.1007/s11934-003-0031-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sildenafil citrate, the first internationally approved and widely used oral agent for the treatment of erectile dysfunction (ED), has revolutionized the treatment of ED throughout the past 5 years. This phosphodiesterase type-5 (PDE-5) inhibitor is selective for corpus cavernosum smooth muscle tissue and produces excellent erectile function. Its efficacy and safety over a wide variety of etiologies of ED and severities of ED demonstrates its usefulness in the clinical treatment of these patients. More than 20 million men have been treated worldwide with sildenafil with excellent results. ED caused by difficult-to-treat etiologies such as radical prostatectomy, severe diabetes, and spinal cord injury have demonstrated efficacy. Although sildenafil citrate, like all PDE-5 inhibitors, is contraindicated in patients taking nitrate medications for cardiac disease, it is effective and safe for those cardiovascular patients who are not taking nitrate medications. The incidence of adverse cardiovascular events in patients taking sildenafil does not differ from those of the general population. Investigations into the pharmacologic effect of sildenafil on coronary myocardial tissue further supports the safety of this medication. Sildenafil has been safe and effective in patients taking various medications including multiple antihypertensive drugs, selective serotonin reuptake inhibitors, cardiac, and diabetic medications.
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Affiliation(s)
- Culley C Carson
- Division of Urology, School of Medicine, University of North Carolina at Chapel Hill, 427 Burnet-Womack Bldg, Campus Box 7235, Chapel Hill, NC 27599-7235, USA.
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Porst H, Padma-Nathan H, Giuliano F, Anglin G, Varanese L, Rosen R. Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial. Urology 2003; 62:121-5; discussion 125-6. [PMID: 12837435 DOI: 10.1016/s0090-4295(03)00359-5] [Citation(s) in RCA: 237] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To examine the therapeutic effects of tadalafil on erectile dysfunction (ED) at 24 and 36 hours after dosing. METHODS A multicenter, randomized, double-blind, placebo-controlled, parallel-group study of 348 men (mean age 57 years) with ED was conducted in Europe and the United States. Patients were stratified by baseline severity of ED using the Erectile Function domain score of the International Index of Erectile Function and then randomly allocated within the severity group to receive tadalafil 20 mg (n = 175) or placebo (n = 173). Subsequently, participants were randomly assigned to two 4-week treatment intervals, during which they were requested to attempt sexual intercourse approximately 24 or 36 hours after tadalafil or placebo dosing. The primary outcome measure was the proportion of successful sexual intercourse attempts (completed to ejaculation) according to patient self-report using the Sexual Encounter Profile diary. RESULTS Of the 348 patients, 327 (94%) completed the trial (163 of 175 in the tadalafil group and 164 of 173 in the placebo group). Thirty-six hours after tadalafil dosing, 59.2% of intercourse attempts were successful versus 28.3% in the placebo group (P <0.001). The proportion of successful intercourse attempts at approximately 24 hours after treatment was also significantly greater with tadalafil (52.9%) than with placebo (29.1%; P <0.001). Tadalafil was well tolerated. The incidences of four treatment-emergent adverse events were significantly greater in the tadalafil group than in the placebo group (all P <0.05): headache, flushing, dyspepsia, and myalgia. CONCLUSIONS Tadalafil 20 mg is an effective and well-tolerated treatment for ED that has a period of responsiveness of up to 36 hours.
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