Erectile function of Chinese men with schizophrenia in psychiatric out-patient clinics and their attitude towards treatment

Prevalence of sexual dysfunction in Chinese patients with schizophrenia: a systematic review and meta-analysis

Background

There may be a higher risk of sexual dysfunction in the schizophrenia population. China has made significant contributions to the global community of patients with schizophrenia. Currently, there is no estimation of the prevalence of sexual dysfunction in Chinese patients with schizophrenia.

Aim

We conducted a meta-analysis to pool the evaluated prevalence of sexual dysfunction in Chinese patients with schizophrenia.

Methods

We systematically searched PubMed, Web of Science, Embase, PsycINFO, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Medical Network, and Huayi Academic Literature Database from inception to September 2023. Meta-analysis was conducted with R version 4.3.1.

Outcomes

To examine the pooled prevalence of sexual dysfunctions among Chinese patients with schizophrenia.

Results

In our meta-analysis, we included 16 studies with 5417 participants, among whom 1727 experienced sexual dysfunction. The results of the meta-analysis reveal that the prevalence of sexual dysfunction in Chinese patients with schizophrenia is 50.43% (95% CI, 37.86%-62.95%). Subgroup analysis results indicate that various factors-including the specific type of dysfunction, duration of illness, assessment tools, mean ages, study region, gender, research setting, marital status, publication years, and type of antipsychotics-all have a particular impact on the occurrence rate of sexual dysfunction in Chinese patients with schizophrenia. Female patients had a slightly higher prevalence of sexual dysfunction than male patients (65.22% vs 54.84%).

Clinical Implications

The findings of this study can be used in high-quality nursing care for the schizophrenia population, particularly for the care of specific sexual dysfunction nursing.

Strengths and Limitations

This meta-analysis is the first to evaluate the prevalence of sexual dysfunction in China among patients with schizophrenia. The limited number of studies is the most important limitation.

Conclusions

The pooled prevalence of sexual dysfunction in Chinese patients with schizophrenia is relatively high, and the prevention and intervention of individual sexual dysfunctions in schizophrenia are advised.

Bias in Evaluating Erectile Function in Lifelong Premature Ejaculation Patients with the International Index of Erectile Function-5

INTRODUCTION

Lifelong premature ejaculation (LPE) is the most important ejaculating dysfunction. Relatively little is known about erectile function in this population.

AIMS

We attempted to evaluate the erectile function of patients with LPE using the International Index of Erectile Function-5 (IIEF-5) to determine if it is sufficiently reliable and accurate to make such an assessment.

METHODS

A total of 406 patients with LPE were enrolled in our study. The participants voluntarily answered the Premature Ejaculation Diagnostic Tool (PEDT) and IIEF-5 questionnaires and underwent a full history evaluation and clinical examination by doctors. Their answers were converted into data analyzed by a statistic software.

MAIN OUTCOME MEASURES

The patients were diagnosed with LPE based on the diagnostic criteria and PEDT scores. The intravaginal ejaculation latency time was recorded according to patient self-reports. The IIEF-5 was used to evaluate their erectile function. Thorough history and clinical examination helped doctors make more correct diagnoses of erectile dysfunction (ED).

RESULTS

Of the 406 patients, 70 (17.24%) patients had ED, as confirmed by doctors. IIEF-5 was accurate for the assessment of the erectile function of LPE patients when the cutoff was decreased to 15.5. Question 5 (1.34 ± 0.53) was the main reason for the drop in the total IIEF-5 score. Questions 1 and 5 shared low consistency with the other three IIEF-5 items, thus they lowered the reliability of the IIEF-5 scores. These questions created a confounding bias that decreased the diagnostic threshold of IIEF-5. However, they could not be removed from the IIEF-5 because they did not reduce its diagnostic accuracy in patients with LPE.

CONCLUSIONS

Bias from questions 1 and 5 lowered the reliability of the IIEF-5 scores; however, it did not reduce the diagnostic accuracy of the IIEF-5. The recommendation is to edit questions 1 and 5 when they are applied to populations with LPE.

Sexual dysfunction improved in heroin-dependent men after methadone maintenance treatment in Tianjin, China

Objective

To investigate whether methadone maintenance treatment (MMT) is correlated with sexual dysfunction in heroin-dependent men and to determine the prevalence and risk factors of sexual dysfunction among men on MMT.

Methods

The study included a retrospective survey and a cross-sectional survey which contained interviews of 293 men who are currently engaged in MMT. The results of the two surveys were compared. For a subset of 43 participants, radioimmunoassay was additionally conducted using retrospective and prospective blood samples to test the levels of plasma testosterone and luteinizing hormone. Other study evaluations were the International Index of Erectile Function (IIEF-15), and Self-rating Depression Scale.

Results

Sexual dysfunction in all five IIEF-15 domains (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) was strongly associated with long-term use of heroin. A decrease in the severity of sexual dysfunction was associated with MMT initiation. Erectile dysfunction, lack of sexual desire, inability to orgasm, and lack of intercourse satisfaction were significantly correlated with increasing age of the participants. Methadone dose and duration of methadone treatment were not found to be associated with sexual dysfunction. The level of plasma testosterone significantly declined during methadone treatment, but results from multivariate analysis indicated low levels of testosterone were not the main cause of sexual dysfunction. No correlation between reported depression status and sexual function was found.

Conclusions

While high levels of sexual dysfunction were reported by heroin-dependent men in our study before and after MMT initiation, MMT appears to be correlated with improved sexual function in the population of the study.

Depressive symptomatology and male sexual functions in late life

BACKGROUND

We aimed to investigate the association between depressive symptoms and various male sexual functions, and to identify which depressive symptoms are most predictive of erectile dysfunction (ED).

METHODS

This was an analytic cross-sectional study with 160 sexually active men aged 50 or above recruited from a large primary care treatment centre. The 5 domains (erectile function, EF; intercourse satisfaction, IS; orgasmic function, OF; sexual desire, SD; overall satisfaction, OS) of the International Index of Erectile Function (IIEF-15) were used to assess various sexual functions. Depressive symptomatology was measured by Geriatric Depression Scale and reconfirmed with General Health Questionnaire.

RESULTS

The level of depressive symptoms was negatively associated with erectile function (p<0.01), orgasmic function (p=0.02), intercourse satisfaction (p=0.04) and overall satisfaction (p<0.01), and was independent of age, education and number of health conditions, but was not associated with sexual desire (p=0.97). Erectile dysfunction was significantly associated with age (OR=1.12; 95% CI 1.05-1.19; p<0.01) and level of depressive symptoms (OR=1.39; 95% CI 1.05-1.85; p=0.02) after multivariate adjustment. In particular, only "low mood" (p=0.03) and "worthlessness" (p=0.03) remained positively associated with ED after multivariate adjustments.

LIMITATIONS

Cross-sectional design cannot demonstrate direction of causality.

CONCLUSIONS

We are the first to implicate "low mood" and "worthlessness" in the association between depressive symptoms and ED, and this is the first study to investigate the association in Chinese.

Prevalence and biopsychosocial correlates of erectile dysfunction in Hong Kong: a population-based study

OBJECTIVES

To describe the prevalence of erectile dysfunction (ED) in Hong Kong and identify the biopsychosocial correlates of ED.

METHODS

This was a descriptive and analytic population-representative cross-sectional study of ED in Hong Kong. The study subjects were 1506 men aged 26 to 70 years, recruited by two-stage stratified random sampling, and interviewed face-to-face by trained interviewers with structured questionnaires.

RESULTS

The overall prevalence of ED was 36.7% (95% confidence interval [CI] 33.7 to 39.7). The age-specific prevalence rate was 18.3% (95% CI 11.1% to 25.4%), 28.6% (95% CI 23.5% to 33.6%), 37.9% (95% CI 32.3% to 43.5%), 47.3% (95% CI 40.1% to 54.5%), and 61.1% (95% CI 51.1% to 71.0%) for the age groups 26 to 30, 31 to 40, 41 to 50, 51 to 60, and 61 to 70 years, respectively. The severity of ED increased with age (P <0.01), and sexual satisfaction decreased with age (P = 0.01). Age (odds ratio [OR] 1.26, P <0.01), living on Hong Kong Island (OR 0.71, P = 0.04), General Health Questionnaire score (OR 1.03, P <0.01), current smokers of 30 or more cigarettes per day (OR 2.11, P = 0.05), and hours spent on work, housework, and self-study (OR 0.945, P = 0.03) were independently associated with ED.

CONCLUSIONS

To our knowledge, this is the first population-representative study of ED in Hong Kong. The prevalence and severity of ED increased with age, and we found biological (age), psychological (General Health Questionnaire), and social (smoking, Hong Kong district, "hours spent on work") factors to have independent influences on ED. The negative association between "hours spent on work" and ED is a novel finding. The results of this study have shown that Hong Kong has a high prevalence of ED compared with Western populations.

Monthly income, standard of living and erectile function in late life

This was a cross-sectional study that enrolled 160 men aged 50 and above who were sexually active (sexual intercourse in the preceding 6 months) from a large primary care treatment centre. The subjects of interest were elderly aged 65 and above, and men aged 50-65 were used for comparison. The overall response rate was 66.9%. The men who participated were generally more affluent. Standard of living was measured by the presence of maid and housing type. Erectile function (EF) score was significantly higher in those who hired maids (P=0.02). Housing type was not associated with erectile dysfunction (ED). In Model A (included both monthly income and education), significant non-parametric correlations were found between monthly income and EF, intercourse satisfaction (IS), orgasmic function (OF) and sexual desire (SD) domains. After statistical adjustments, only EF (P<0.01) and IS (P=0.04) remained positively associated with monthly income. OF was negatively associated with age (P<0.01) and diabetes (P=0.04), whereas SD was negatively associated with age (P<0.01) in the multivariate analysis. Overall satisfaction was not significantly associated with any factor. In Model B (excluded monthly income from analysis), education attainment was positively associated with OF (P=0.04), but was not significant after adjustment for multiple testing. In the final multivariate model, only monthly income (P<0.01) and age (P<0.01), but not education (P=0.47), remained significantly associated with EF. This study suggests the influence of social determinants on EF and that this influence can extend into late life.

Sexual dysfunction in men treated with depot antipsychotic drugs: a pilot study

Background: Sexual dysfunction is common, but often under-recognised, in people with schizophrenia. Many antipsychotic drugs are known to cause prolactin elevation, and it is often assumed that sexual dysfunction is a consequence of prolactin elevation. We investigated the relationship between sexual function and serum concentrations of prolactin and testosterone in men receiving regular long-acting depot injections of antipsychotic medication. Methods: Twenty-two men attending a community depot clinic participated. A structured interview was used to collect information about sexual function, and serum prolactin and testosterone concentrations were measured. Results: Sexual dysfunction was common, with 73% of men reporting problems in at least one area of sexual function. Six men had elevated serum prolactin and one had reduced serum testosterone. Antipsychotic drug dose was positively correlated with serum prolactin and negatively correlated with serum testosterone, but there was no association between serum prolactin or testosterone concentrations and any measure of sexual dysfunction. Conclusion: Sexual dysfunction is a major problem for men living with chronic schizophrenia, but our results suggest that it is not directly attributable to elevated prolactin or reduced testosterone concentrations.

Depression and lower urinary tract symptoms: Two important correlates of erectile dysfunction in middle-aged men in Hong Kong, China

AIM

To evaluate the correlates of erectile dysfunction (ED) in Hong Kong middle-aged Chinese men aged 45-64 years.

METHODS

A community-based cross-sectional household survey was performed in Hong Kong. The Chinese abridged version of the International Index of Erectile Function (IIEF-5) was used to measure erectile function. The International Prostate Symptom Score (IPSS) was used to measure lower urinary tract symptoms (LUTS) and depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Demographic and lifestyle data were also collected. The association between ED and its correlates was analyzed using bivariate and multivariate analyses.

RESULTS

Of the 545 subjects who agreed to participate in the survey, 75 refused to answer questions about their sexual activities and function. Out of those who responded, 118 (22%) subjects were not sexually active (not sexually active over the past 4 weeks). Out of 352 subjects, 60.3% suffered from some degree of ED. Age, presence of depression defined by CES-D and moderate LUTS were associated with increased odds of having ED. In multivariate analysis, depressive symptoms identified by CES-D (OR = 2.3, CI: 1.2-4.6) and moderate LUTS (OR = 3.7, CI: 1.6-8.3) were independently associated with increased odds of having ED.

CONCLUSION

ED is an important public health problem in Chinese middle-aged men, with more than half suffering from some degree of ED. Depression and LUTS were significant and important risk factors associated with ED.