Smoking and erectile dysfunction: findings from a representative sample of Australian men

Influence of substance use on male reproductive health and offspring outcomes

The prevalence of substance use globally is rising and is highest among men of reproductive age. In Africa, and South and Central America, cannabis use disorder is most prevalent and in Eastern and South-Eastern Europe, Central America, Canada and the USA, opioid use disorder predominates. Substance use might be contributing to the ongoing global decline in male fertility, and emerging evidence has linked paternal substance use with short-term and long-term adverse effects on offspring development and outcomes. This trend is concerning given that substance use is increasing, including during the COVID-19 pandemic. Preclinical studies have shown that male preconception substance use can influence offspring brain development and neurobehaviour through epigenetic mechanisms. Additionally, human studies investigating paternal health behaviours during the prenatal period suggest that paternal tobacco, opioid, cannabis and alcohol use is associated with reduced offspring mental health, in particular hyperactivity and attention-deficit hyperactivity disorder. The potential effects of paternal substance use are areas in which to focus public health efforts and health-care provider counselling of couples or individuals interested in conceiving.

Awareness of hazards due to tobacco among people aged 15 years and older in Chongqing, China, in 2020: A cross-sectional analysis

INTRODUCTION

Tobacco smoke contains a large number of harmful substances and carcinogens. Smoking and secondhand smoke cause a variety of cancers and diseases, seriously endangering human health. However, the status and characteristics of the awareness of hazards due to tobacco among people aged ≥15 years in Chongqing, China, are still unknown.

METHODS

A multistage stratified cluster random sampling method was used to select ten districts and counties in Chongqing Municipality, China and a total of 6622 people were investigated between August and October 2020. The chi-squared test was used to analyze the awareness of hazards due to tobacco in various populations after the data had been cleaned and weighted.

RESULTS

In 2020, the awareness rates of people aged ≥15 years in Chongqing, China, about a specific disease caused by smoking were lung cancer (77.1%), heart disease (45.1%), stroke (40.1%), and penile erectile dysfunction (24.2%). However, only 22.1% of the respondents knew that smoking could simultaneously lead to all four diseases mentioned above. Adult lung cancer was the disease with the highest awareness rating (72.5%), followed by children's lung disease (54.2%) and adult heart disease (46.1%). A total of 42.0% of respondents knew that secondhand smoke could cause the three diseases simultaneously. Only 22.0% of those correctly understood the harm of low-tar cigarettes. The logistic regression results showed that education level and occupation were risk factors for lack of awareness of hazards due to tobacco. In contrast, media campaigns on tobacco control were a protective factor.

CONCLUSIONS

The awareness of hazards due to tobacco among people aged ≥15 years in Chongqing, China, still needs to be improved. More graphic health warning labels and mass media campaigns about the hazards of tobacco should be carried out to raise people's awareness and warn about the health risks of smoking.

Prevalence and the Associated Factors of Erectile Dysfunction Among Saudi Married Males

OBJECTIVES

To estimate the prevalence of erectile dysfunction (ED) and to determine the associated factors of erectile dysfunction among Saudi married male subjects.

METHODS

 A cross-sectional study based on data collected from 313 male subjects. The questionnaire was given to the randomly selected subjects from the appointment list in KKUH outpatient clinics using a simple random sampling method. The study questionnaire included the following sections: demographic, lifestyle, and medical history. The international index of erectile function-15 (IIEF-15) scale was used to assess ED. Statistical analyses were done using Statistical Package for Social Sciences (SPSS, IBM Corp., Armonk, NY, USA).

RESULTS

 Out of 313 participants 33 had ED (10.53%). The associated factors were age (odds ratio= 14.4), lower education level (odds ratio= 15.85), mild physical activity (odds ratio= 7.69), and medical conditions like diabetes mellitus, hypertension, and hypercholesteremia (odds ratio= 3.6).

CONCLUSION

 The diagnosis of ED in Saudi Arabia is underestimated and services for the diagnosis and treatment should be provided for diabetes, hypertension, hypercholesteremia and elderly patients.

A Meta-Analysis of Erectile Dysfunction and Alcohol Consumption

PURPOSE

The purpose of the study was to evaluate the association between alcohol consumption and risk of erectile dysfunction (ED).

METHODS

PubMed was searched for reports published before June 2019. Data were extracted and combined odds ratios (ORs) calculated with random-effects models.

RESULTS

Finally, 46 studies were included (216,461 participants). The results of our meta-analysis indicated that there was a significant association between regular alcohol consumption and ED (OR 0.89, 95% confidence interval [CI]: 0.81-0.97). There was no indication of publication bias (Egger's test, p = 0.37). In the stratified analysis, the pooled OR of ED for light to moderate and high alcohol consumption was 0.82 (95% CI: 0.72-0.94) and 0.82 (95% CI: 0.67-1.00), respectively. No variable related to the source of heterogeneity was found in univariate and multivariate meta-regression analyses. A dose-response meta-analysis suggested that a nonlinear relationship between alcohol consumption and risk of ED was observed (p for nonlinearity <0.001).

CONCLUSION

A J-shaped relationship between alcohol consumption and risk of ED was observed. Alcohol should be taken in moderate quantities in order to obtain the dual effect of disinhibition and relaxation. If taken chronically, it could provoke vascular damages.

Associations between smoking, sex hormone levels and late-onset hypogonadism in men differ depending on age

Few studies have investigated whether associations between smoking, sex hormone levels, and symptoms of late-onset hypogonadism (LOH) in men are affected by age. This multi-center, cross-sectional study involving 6,296 men aged 40-79 years was conducted between June 1, 2013 and August 31, 2016 in 6 provinces of China. Total testosterone, free testosterone, and Aging Males’ Symptoms scale (AMS) scores were compared depending on smoking status and the number of cigarettes smoked. Total testosterone was higher in smokers than in non-smokers in all except the 70-79 year old subgroup. Free testosterone was higher in smokers than non-smokers for the 40-49 and 50-59 year old subgroups, but not the 60-69 and 70-79 year old subgroups. Total testosterone was positively associated with number of cigarettes consumed in smokers aged 40-49 and 50-59 years. Sexual and somatic AMS scores were higher in current and ex-smokers than in non-smokers in all age subgroups from 40 to 79 years and were negatively associated with cigarette consumption in smokers aged 40-49 years. These results indicate that, as men age, the positive association between smoking and testosterone weakens, while the positive association between smoking and LOH symptoms becomes stronger.

Prevalence and factors associated with erectile dysfunction among adult men in Moshi municipal, Tanzania: community-based study

Background

Erectile dysfunction (ED) has a negative impact on ones’ relationships with poor quality of life as inevitable result. The effects of ED maybe worse in developing countries setting like Tanzania because men’s sexual health has been forgotten. Men’s sexual and reproductive health needs are not in the national reproductive health strategic. This study aimed to determine the prevalence and factors associated with erectile dysfunction among adult men in Moshi municipality, northern Tanzania.

Results

The mean age of the 381 men was 39.6 (SD ±16.8) years. The overall prevalence of ED on this study was 29.7%. The severity of ED among study participants was; 13.4% (51), 9.7% (37), 3.7% (14), 2.9% (11) had mild, mild to moderate, moderate and severe erectile dysfunction respectively. Age 40–54 years (Adjusted OR 5.0, 95% CI 2.5–9.9), > 55 years (aOR 11.7, 95% CI 5.8–23.7) and hypertension (aOR 2.6, 95% CI 1.1–6.4) were independent predictors of ED respectively.

Conclusion

The prevalence of ED is high among men in Moshi municipal as 1 out of 3 men have ED. Age and hypertension were independent predictors of ED. These results point to the need of community awareness and education programs to raise awareness among men about existence of ED problem, its consequence and where they can get advice and care in this setting. Further, health providers taking care of hypertensive and men with DM should be equipped with knowledge and skills on early detection for ED and how to counsel and where to refer patients for help.

Association between Frailty and Erectile Dysfunction among Chinese Elderly Men

Objective

This study is aimed at assessing association between frailty and erectile dysfunction among Chinese elderly men.

Methods

This community-based study was conducted with a sample of 341 Chinese elderly men (aged 60 to 83 years old) in Fuyang City (Anhui Province, China). Each of the participants completed a standard questionnaire, including demographics (age, height, weight, yearly income, educational status, comorbidity, lifestyle factors, etc.), medical and sexual history, and the Chinese version of Tilburg Frailty Indicator (TFI) and International Index of Erectile Function-5 (IIEF-5) for assessing frailty and erectile dysfunction (ED).

Results

The prevalence of ED and frailty in Chinese elderly men was 77.13% and 68.04%, respectively. Compared with the non-ED group, the ED group had increased age, spouse's age, BMI, prevalence of diabetes, and scores of TFI and lower yearly income, educational levels, and ratio of irregular intercourse (less than once per week) (all P < 0.05). Multivariate analysis indicated that age (OR: 0.860, 95% CI: 0.763-0.969), diabetes (OR: 0.330, 95% CI: 0.165-0.661), irregular intercourse (OR: 3.416, 95% CI: 1.874-6.229), and scores of TFI (OR: 0.906, 95% CI: 0.846-0.970) were regarded as independent risk factors for ED (all P < 0.05). And after adjusting for age, the TFI score had a negative significant association with the IIEF score (r = −0.134, P = 0.013).

Conclusion

This study confirmed the strong associations between ED and frailty among elderly men. Sexual health care for elderly men with ED should be assessed and taken addressed on the multidimensional assessments of frailty.

Contemporary Vistas in Geriatric Sexuality

There is a substantial increase in the total geriatric population worldwide. This change in demography calls for a greater, deeper, and thorough understanding of elderly and age-related issues. Even though sexuality is a basic and vital driving force, human sexuality, especially elderly sexuality, is frequently misunderstood. Many myths and misconceptions regarding elderly sexuality exist which need attention. Contrary to the popular belief, studies reveal that sexual life continues to be an important aspect in later life and is often viewed by elderly as an expression of love, passion, affection, admiration, and loyalty. Various factors play a role in elderly sexuality including that of bio-psycho-social factors, changes in the body, presence of comorbid conditions along with sexual disorders. Sexual disorders, if present, should be treated and addressed adequately.

Effect of cigarette smoking on sexual functions, psychological factors, and disease activity in male patients with ankylosing spondylitis

OBJECTIVE

This study aims to investigate the effect of smoking on sexual functions in AS patients.

PATIENTS AND METHODS

A total of 67 male AS patients with a median age of 34 years (range: 18-57) reporting sexual activity at least for the past 4 weeks period were included. Patients were divided into smokers (Group 1, n = 47) and non-smokers (Group 2, n = 20). Fagerström test for nicotine dependence, smoking history, exhaled carbon monoxide test were recorded for smoking AS patients. Visual analogue scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL), International Index of Erectile Function (IIEF), Beck Depression Inventory (BDI) were filled for both groups.

RESULTS

There was no significant difference between smokers and non-smokers in all evaluation parameters. BASMI scores were significantly lower in the mild dependency subgroup as compared to those with moderate or severe dependency (p = .005 and p = .007, respectively). Total IIEF score and IIEF categories correlated significantly with BASDAI, BASFI, BASMI, ASQoL, pain, fatigue, and cumulative smoking. BDI showed an inverse correlation with the IIEF score and IIEF category (p < .001 r = -0.520, p < .001 r = -0.508, respectively).

CONCLUSIONS

Sexual function in AS patients is associated with the pain, fatigue, disease activity, functional status, quality of life, depression as well as the cumulative exposure to smoking, and that sexual functions tend to decline with increasing degree of cigarette dependency.

Alcohol consumption and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: Baseline data from the Dogo Study

Diabetes mellitus and heavy alcohol consumption are both associated with vascular disease, a category that includes erectile dysfunction (ED). However, the association between alcohol consumption and ED among patients with type 2 diabetes mellitus remains unclear. The aim of the present multicenter cross-sectional study was to investigate the relationship between drinking frequency, weekly alcohol consumption, daily alcohol consumption, and ED among Japanese patients with type 2 diabetes mellitus. Study subjects were 340 male Japanese patients with type 2 diabetes mellitus, aged 19-70 years, who had undergone blood tests at our institutions. A self-administered questionnaire was used to collect information on the variables under study. ED was defined as present when a subject had a Sexual Health Inventory for Men score <8. Adjustment was made for age, body mass index, duration of type 2 diabetes mellitus, current smoking, hypertension, dyslipidemia, glycated hemoglobin, stroke, coronary artery disease, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. The prevalence of ED was 43.2% (147/340). The frequency of alcohol consumption and weekly alcohol consumption were independently inversely associated with ED (p for trend p = 0.001 and 0.004, respectively). The relationship between daily alcohol consumption and ED was an inverted J-shaped curve: alcohol consumption of less than 60 g, but not 60 g or more, per day was independently related to a lower prevalence of ED (p for quadratic trend = 0.003). In Japanese men with type 2 diabetes mellitus, an inverted J-shaped relationship between daily alcohol consumption and ED was observed, while frequency of alcohol consumption and weekly alcohol consumption were significantly inversely associated with ED.

Sexual dysfunction in men diagnosed as substance use disorder

Illicit drugs are often used as aphrodisiacs to enhance sexual performance and/or pleasure; however, the available data suggest that most illicit drugs have adverse effects on erection, sexual desire and ejaculation latency in males and that these effects are not fully understood. This study aimed to determine the effect of illicit drug abuse on male sexual function, based on the International Index of Erectile Function (IIEF) score. This descriptive study was conducted at the Alcohol and Substance Research Treatment and Education Center, Ankara, Turkey. Males diagnosed as substance use disorder according to DSM-IV (n = 101) were included as the patient group, and age-matched healthy male volunteers (n = 43) were included as the control group. A 30-item sociodemographic interview form developed by researchers and the 15-item IIEF were administered to all the participants. Data were compared between the patient and control groups. Mean IIEF score was 46.7 ± 3.3 in the patients that used alcohol, 23.7 ± 3.3 in the opioid users, 34.1 ± 5.3 in the ecstasy users, 43.5 ± 4.2 in the cannabis users and 55.3 ± 1.6 in the control group. There was not a significant difference between the alcohol and cannabis users' mean IIEF scores and that in the control group (P > 0.05 and >0.05 respectively), whereas there was a significant difference between the opioid and ecstasy users' mean IIEF scores and that in the control group (P < 0.001 and <0.001 respectively). All IIEF subscale scores in the opioid users were significantly lower than in the control group (P < 0.001). IIEF erectile function, sexual desire and general satisfaction subscale scores were significantly lower in the ecstasy users than in the control group (P < 0.001, <0.005 and <0.001 respectively). In the alcohol users only, the IIEF general satisfaction subscale score was lower than in the control group (P < 0.005).

Association of quantity and duration of smoking with erectile dysfunction: a dose-response meta-analysis

INTRODUCTION

Some original studies and a recent meta-analysis suggested that smoking could be associated with the risk of erectile dysfunction (ED), but the dose-response relationship between them was unclear.

AIM

The aim of this study was to investigate the potential association between quantity and duration of smoking and the risk of ED.

METHODS

We conducted a literature search of PubMed, Embase, Web of Science, and Scopus from these databases' inception through March 2014 for observational epidemiological studies examining the association between smoking and risk of ED. Random-effects meta-analyses were used to combine the results of included studies.

MAIN OUTCOME MEASURE

Quantitative review of published observational epidemiological studies on the association between smoking and risk of ED was the main outcome measure.

RESULTS

One cohort study and nine cross-sectional studies were eligible for inclusion in the meta-analysis (50,360 participants and 12,218 cases with ED). No evidence of a curve linear association was observed between smoking and risk of ED. The summary odds ratio of ED for an increase of 10 cigarettes smoked per day was 1.14 (95% confidence interval 1.09 to 1.18), with moderate heterogeneity (P = 0.061, I(2)  = 44.7%). For an increment of 10 years of smoking, the combined odds ratios of ED was 1.15 (95% confidence interval 1.10 to 1.19), without substantial heterogeneity (P = 0.522, I(2)  = 0.0%).

CONCLUSIONS

Evidence from observational studies suggests that there is a positive dose-response association between quantity and duration of smoking and risk of ED.

Golombok Rust Inventory of Sexual Satisfaction for the presence of sexual dysfunction within a Ghanaian urological population

Sexual dysfunction (SD) is devastating to a man's ego and its presence could defeat his purpose of masculinity. A number of studies have explored and reported on existing comorbidities between SD and medical conditions for which urological problems are no exception. However, in Ghana there is paucity of data exploring the epidemiological, etiological and health associations of medical conditions with SD. This study was therefore conducted to determine the prevalence, types and determinants of SD in a sample of Ghanaian men with urological conditions. This descriptive cross-sectional study was carried out between December 2012 and April 2013 at the Urology clinic of the Tamale Teaching Hospital in the Northern Region of Ghana. A total of 200 participants were enrolled in the study. All participants were evaluated by using a semistructured questionnaire and the Golombok Rust Inventory of Sexual Satisfaction questionnaire. An overall response rate of 47.5% was estimated after 69 patients refused to partake in the study; 6 patients found the questionnaire too sensitive and refused to participate and 30 participants returned incomplete questionnaire. The mean age of the participants was 36.5±13.8 years and ranged from 18 to 70 years. The estimated prevalence of SD was 71.6%. The prevalence of the various SD domains was as follows: non-sensuality (71.6%), premature ejaculation (70.5%), non-communication (69.5%), impotence and infrequency (68.4%), dissatisfaction (61.1%) and avoidance (57.9%). Participants who were married, consumed alcoholic beverages, smoked cigarettes and aging males who had children were at a greater risk of developing SD. Urologic patients have a high prevalence of SD that is dependent on marital status, alcohol consumption, smoking status and aged patients with children.

Substance use disorders in men presenting to a psychosexual clinic

Introduction. Substance use disorders (SUDs) are commonly associated with a variety of psychiatric disorders. Community-based studies have found a significant association between SUDs and sexual dysfunction in men, with a possible causal relation in the case of nicotine. Methods. The case records of 105 men presenting to a clinic for patients with psychosexual disorders were reviewed. Men with and without comorbid SUDs were compared in terms of demographic, clinical, and familial variables. Results. 25 of the 105 men (23.8%) had a lifetime diagnosis of SUD, and 19 (18.1%) had a current SUD. The commonest substances involved were nicotine (n = 21, 20%) and alcohol (n = 9, 9.5%). Men with comorbid SUDs were more likely to report a family history of substance dependence, particularly alcoholism. Single men with SUDs were more likely to have a comorbid mood disorder. Conclusion. SUDs, particularly nicotine and alcohol use disorders, are common comorbidities in patients with psychosexual disorders. Identifying and treating these disorders in this population are important aspects of management.

Racial differences in sexual dysfunction among postdeployed Iraq and Afghanistan veterans

This study examined the racial/ethnic differences in prevalence and risk factors of sexual dysfunction among postdeployed Iraqi/Afghanistan veterans. A total of 3,962 recently deployed veterans were recruited from Houston Veterans Affairs medical center. The authors examined sociodemographic, medical, mental-health, and lifestyle-related variables. Sexual dysfunction was diagnosed by ICD9-CM code and/or medicines prescribed for sexual dysfunction. Analyses included chi-square, analysis of variance, and multivariate logistic regression. Sexual dysfunction was observed 4.7% in Whites, 7.9% in African Americans, and 6.3% in Hispanics. Age, marital status, smoking, and hypertension were risk factors for Whites, whereas age, marital status, posttraumatic stress disorder and hypertension were significant for African Americans. For Hispanics, only age and posttraumatic stress disorder were significant. This study identified that risk factors of sexual dysfunction varied by race/ethnicity. All postdeployed veterans should be screened; and psychosocial support and educational materials should address race/ethnicity-specific risk factors.

Incidence and persistence/recurrence of men's sexual difficulties: findings from the Australian Longitudinal Study of Health and Relationships

This study presents data on the prevalence, incidence, and persistence/recurrence of 8 sexual difficulties among men. Participants were 3,157 Australian men who were administered 2 computer-assisted interviews approximately 12 months apart. Analyses were based on a weighted sample of 2,158 men who were 20-64 years of age, sexually active in the past 12 months, and in the same heterosexual relationship at both interviews. Upon recruitment, a third of men (34%) reported having 1 or more sexual difficulties. At follow-up, 21% reported a new sexual difficulty. The 2 highest incident difficulties were "lacking interest in having sex" (11%) and "reaching orgasm too quickly" (7%). In addition, 51% of men with 1 or more sexual difficulties at recruitment reported having at least 1 of these difficulties again at follow-up. While "trouble keeping an erection" had the highest persistence/recurrence (48%), "taking too long to orgasm" had the lowest (24%). Logistic regression modeling revealed a greater incidence of orgasmic difficulties among older and less educated men. There were few sociodemographic predictors of persistence/recurrence. These data should assist clinicians and other health service providers in identifying the potential challenges faced by men who experience sexual difficulties.

The Global Online Sexuality Survey (GOSS): erectile dysfunction among Arabic-speaking internet users in the Middle East

INTRODUCTION

Epidemiologic studies exploring sexuality across different cultures and geographic regions are scanty, particularly from the Middle East. The Global Online Sexuality Survey (GOSS) is an Internet-based survey investigating male and female sexual function. GOSS-Arabic-Males is the Arabic version targeting males in the Middle East, exploring prevalence rate of and factors affecting erectile dysfunction and its therapeutic trends, as well as premature ejaculation, attitudes toward genital size, and contraception.

AIM

To explore epidemiologic aspects of male sexuality through an online survey.

MAIN OUTCOME MEASURES

Prevalence rate of erectile dysfunction, its relationship to risk factors, and therapeutic trends.

METHODS

The online survey was randomly offered to Web surfers in the Middle East.

RESULTS

Eight hundred four subjects completed the survey. The overall prevalence of ED was 45.1%, strongly correlating with various risk factors studied, including age, diabetes, hypertension under treatment, depression, concerns over genital size, interpersonal distress, premature ejaculation, low libido, and subjective reports of penile deviation. Adjusted to the World Standard Population, the prevalence rate for ED was 47%. Phosphodiesterase (PDE) inhibitors gave a poor response among those with low libido and interpersonal distress, emphasizing the need for proper diagnosis and psychological counseling parallel to medical treatment. Furthermore, PDE inhibitors were stigmatized with unrealistic concerns that decreased their utility to a great extent.

CONCLUSION

In the study population of Arab-speaking Internet users, prevalence of erectile dysfunction and effect of risk factors have proven similar to reports from different parts of the world, though not unanimously. Premature ejaculation, low desire, concerns over penile size, and penile curvature are factors to be considered in the evaluation of ED patients. PDE inhibitors are stigmatized with false beliefs that should be addressed through mass media and counseling if this population is to take full benefit from this therapeutic option.

Smoking-cessation and adherence intervention among Chinese patients with erectile dysfunction

BACKGROUND

Whether the association between smoking and erectile dysfunction is causal is uncertain. No RCTs have been previously conducted on cessation counseling and additional nicotine replacement therapy (NRT) adherence counseling among smokers with erectile dysfunction.

PURPOSE

The aim of the study was to determine if smoking-cessation counseling in conjunction with NRT increases quitting and NRT adherence compared to usual care, and if stopping smoking would improve erectile function among Chinese erectile dysfunction patients who smoke.

DESIGN

An RCT was conducted. Data were collected in 2004-2007 and analyzed in 2008.

SETTING/PARTICIPANTS

The sample included 719 Chinese adult erectile dysfunction patients who smoked at least 1 cigarette per day, intended to quit smoking within the next 7 days, and would use NRT.

INTERVENTIONS

Group A1 received 15-minute smoking-cessation and 3-minute NRT adherence counseling at baseline, 1 week, and 4 weeks with free NRT for 2 weeks. Group A2 received the same treatment, except for the adherence counseling. Group B received 10 minutes of quitting advice. All subjects received a self-help quitting booklet at first contact.

MAIN OUTCOME MEASURES

Self-reported 7-day tobacco abstinence at 6 months, 4-week NRT adherence at 1 month, and improvement in erectile dysfunction condition at 6 months.

RESULTS

The intervention groups (A1+A2) achieved higher rates of abstinence, both self-reported (23% vs 12.8%, RR=1.79, 95% CI=1.22, 2.62) and biochemically validated (11.4% vs 5.5%, RR=2.07, 95% CI=1.13, 3.77), than the control group. The NRT adherence rate did not differ between Groups A1 and A2 (13.7% vs 12.7%, RR=1.08, 95% CI=0.69, 1.69). An improvement in erectile dysfunction status from baseline to 6 months was associated with self-reported quitting at 6 months but not with intervention status.

CONCLUSIONS

Although quitting smoking was associated with improvement in erectile dysfunction, this study found significant outcome differences among the means used to achieve smoking cessation.

TRIAL REGISTRATION

ISRCTN13070778.

Is obesity a further cardiovascular risk factor in patients with erectile dysfunction?

INTRODUCTION

Erectile dysfunction (ED) and, in particular, arteriogenic ED have been proposed as new markers of risk for incident major adverse cardiovascular events (MACE). Reduced penile blood flow is more common in obese people than in leaner ED subjects.

AIM

To explore the interaction of overweight/obesity and penile blood flow in the prediction of incident MACE.

METHODS

This is an observational prospective cohort study evaluating a consecutive series of 1,687 patients attending our andrological unit for ED. Different clinical, biochemical, and instrumental (penile flow at color Doppler ultrasound: PCDU) parameters were evaluated.

MAIN OUTCOMES MEASURES

According to body mass index (BMI), subjects were divided into three groups: normal weight (BMI = 18.5-24.9 kg/m(2)), overweight (BMI = 25.0-29.9 kg/m(2)), and obese (BMI >or= 30.0 kg/m(2)). Information on MACE was obtained through the City of Florence Registry Office.

RESULTS

Among patients studied, 39.8% were normal weight, while 44.1% and 16.1% showed BMI 25-29.9 and 30 kg/m(2) or higher, respectively. During a mean follow-up of 4.3 +/- 2.6 years, 139 MACE, 15 of which were fatal, were observed. Cox regression model, after adjusting for age and Chronic Diseases Score, showed that obesity classes along with the presence of arteriogenic ED (peak systolic velocity at PCDU <25 cm/second) were significantly and independently associated with incident MACE (hazard ratio = 1.47 [1.1-1.95], P < 0.05 and 2.58 [1.28-5.09], P < 0.001, respectively). When a separate analysis was performed for classes of obesity, reduced peak systolic velocity at PCDU (<25 cm/second) was significantly associated with incident MACE in obese (BMI >or= 30 kg/m(2)), but not in leaner, subjects.

CONCLUSIONS

In obese subjects, more than in leaner ED subjects, impaired penile blood flow is associated with an increased risk of incident cardiovascular disease. The interaction with concomitant risk factors, such as obesity, should be taken into account when assessing the predictive value of penile blood flow for cardiovascular diseases.

Safety of sildenafil citrate: review of 67 double-blind placebo-controlled trials and the postmarketing safety database

AIM

To review special safety topics associated with sildenafil and to document the tolerability of 50- and 100-mg doses, overall and by age, in men with erectile dysfunction (ED).

METHODS

Data were collated from 67 double-blind placebo-controlled (DBPC) trials (> 14,000 men) conducted by the manufacturer and from the manufacturer's postmarketing safety database (39,277 patients). The DBPC data were stratified by dose, starting dose and age (> or = 65 and > or = 75 years). Special safety topics included cardiovascular risk, priapism, non-arteritic anterior ischaemic optic neuropathy (NAION), impaired renal and hepatic function, drug interactions (i.e. nitrates, cytochrome P3A4 inhibitors, other ED therapies and alpha-blockers) and incorrect use.

RESULTS

Sildenafil was well tolerated at a dose of 50 or 100 mg in men with ED, overall, in those aged > or = 65 years, and in those aged > or = 75 years. Analyses of the databases did not reveal any causal link between sildenafil and cardiovascular events, or any new safety risks relating to cardiovascular events, priapism, NAION, hearing loss or drug interactions. In the small number of men with moderate impairment of renal function or hepatic function who were treated with sildenafil in DBPC trials, the safety profile was similar to that in men with no impairment of renal or hepatic function. Overdose with sildenafil was rare in the ED population. No new safety issues, emerging trends or adverse reactions were identified in conjunction with overdose, dependence, abuse or misuse.

CONCLUSION

This collated review confirms generally the good tolerability and established safety profile of sildenafil 50 and 100 mg in men with ED and reveals no new safety issues.

Alcohol consumption and male erectile dysfunction: an unfounded reputation for risk?

INTRODUCTION

Alcohol consumption is a contentious social topic and is often assumed to have deleterious effects on sexual performance. There is a lack of consensus on whether alcohol consumption may in fact be beneficial to erectile function.

AIM

We examined the data from a population-based cross-sectional study of men's health to assess the association between usual alcohol consumption and erectile dysfunction (ED).

METHOD

Reply-paid questionnaires were posted to a randomly selected age-stratified male population sample obtained from the Western Australian (WA) Electoral Roll.

MAIN OUTCOME MEASURES

The survey questionnaire included sociodemographic details, self-reported clinical information, and drinking habits. The 5-item International Index of Erectile Function (IIEF-5) was used to assess erectile function.

RESULTS

Most (87%) participants were current alcohol drinkers, with binge drinking, as defined by the Australian National Health and Medical Research Council (NHMRC), reported by 20% of drinkers. Compared with never-drinkers, the age-adjusted odds of ED were lower among current, weekend, and binge drinkers and higher among ex-drinkers. Among current drinkers, the odds were lowest for consumption within the NHMRC guidelines of between 1 and 20 standard drinks a week. On further adjustment for cardiovascular disease (CVD) or for cigarette smoking, age-adjusted odds of ED were reduced by 25-30% among alcohol drinkers.

CONCLUSIONS

Our findings suggest a modest negative association between alcohol consumption and ED and confounding of the association by CVD and cigarette smoking. The Western Australia Men's Health Study certainly provides no justification for advising men with ED whose drinking habits are consistent with NHMRC guidelines that they should cease or reduce their consumption of alcohol.

Sildenafil inhibits superoxide formation and prevents endothelial dysfunction in a mouse model of secondhand smoke induced erectile dysfunction

PURPOSE

We determined the effect of passive secondhand cigarette smoke on 1) erectile function in vivo, 2) molecular mechanisms involved in penile vascular function, and 3) erectile function and penile molecular signaling in the presence of phosphodiesterase type 5 inhibitor therapy.

MATERIALS AND METHODS

Four groups of mice were used, including group 1--controls, group 2--mice exposed to 3 weeks of secondhand smoke (5 hours per day for 5 days per week), group 3--control plus sildenafil (100 mg/kg per day) and group 4--smoke exposed plus sildenafil (100 mg/kg per day). Cavernous nerve electrical stimulation and intracavernous injection of acetylcholine were done to assess erectile function. Constitutive and inducible nitric oxide synthase activity, reactive oxygen species generation, nitrotyrosine formation and superoxide anion levels were assessed.

RESULTS

Decreased erectile responses to cavernous nerve electrical stimulation and impaired endothelium dependent erectile responses to ACh in mice exposed to secondhand smoke were observed. Superoxide anion was increased in endothelial and corporeal smooth muscle cells of smoking mouse penises. In mice exposed to secondhand smoke constitutive nitric oxide synthase activity was decreased, and inducible nitric oxide synthase activity, reactive oxygen species generation and nitrotyrosine formation increased. Sildenafil therapy restored constitutive nitric oxide synthase activity in the penis of smoking mice, decreased inducible nitric oxide synthase activity, reactive oxygen species generation and nitrotyrosine formation, and improved erectile responses to cavernous nerve electrical stimulation and acetylcholine.

CONCLUSIONS

Short-term exposure to secondhand smoke impairs erectile function through excessive penile reactive oxygen species signaling and inducible nitric oxide synthase activity. Decreased penile constitutive nitric oxide synthase activity may be attributable to the decreased endothelial nitric oxide synthase activity resulting from increased oxidative stress. Sildenafil therapy restored nitric oxide synthase activity and decreased reactive oxygen species signaling, resulting in improved erectile function.

Cigarette smoking and erectile dysfunction: focus on NO bioavailability and ROS generation

INTRODUCTION

Thirty million men in the United States suffer from erectile dysfunction (ED) and this number is expected to double by 2025. Considered a major public health problem, which seriously affects the quality of life of patients and their partners, ED becomes increasingly prevalent with age and chronic smoking is a major risk factor in the development of ED.

AIM

To review available evidence concerning the effects of cigarette smoking on vascular changes associated with decreased nitric oxide (NO) bioavailability and increased reactive oxygen species (ROS) generation.

METHODS

We examined epidemiological and clinical data linking cigarette smoking and ED, and the effects of smoking on vascular NO bioavailability and ROS generation.

MAIN OUTCOME MEASURES

There are strong parallels between smoking and ED and considerable evidence supporting the concept that smoking-related ED is associated with reduced bioavailability of NO because of increased ROS.

RESULTS

Cigarette smoking-induced ED in human and animal models is associated with impaired arterial flow to the penis or acute vasospasm of the penile arteries. Long-term smoking produces detrimental effects on the vascular endothelium and peripheral nerves and also causes ultrastructural damage to the corporal tissue, all considered to play a role in chronic smoking-induced ED. Clinical and basic science studies provide strong indirect evidence that smoking may affect penile erection by the impairment of endothelium-dependent smooth muscle relaxation or more specifically by affecting NO production via increased ROS generation. Whether nicotine or other products of cigarette smoke mediate all effects related to vascular damage is still unknown.

CONCLUSIONS

Smoking prevention represents an important approach for reducing the risk of ED. The characterization of the components of cigarette smoke leading to ED and the mechanisms by which these components alter signaling pathways activated in erectile responses are necessary for a complete comprehension of cigarette smoking-associated ED.

Alcohol consumption and erectile dysfunction: meta-analysis of population-based studies

Alcohol is long regarded as a risk factor for erectile dysfunction (ED), but epidemiological evidence has been equivocal. We aimed to investigate the ED risk associated with various levels of alcohol consumption by meta-analysis. We searched for population-based studies on ED through Medline, PubMed, PsychInfo, and scanned through reference lists. Eleven cross-sectional studies were included and analyzed with random effects model. We reviewed the results from one cross-sectional study and two cohort studies. Regular alcohol consumption was negatively associated with ED (odds ratio (OR)=0.79; 99% confidence interval (CI), 0.67-0.92; P<0.001). Consumption of 8 or more drinks/week significantly reduced the risk of ED (OR=0.85; 99% CI, 0.73-0.99; P=0.007), but consumption of less alcohol (1-7 drinks/week) was not significant (OR=0.73; 99% CI, 0.44, 1.20; P=0.101). Begg's test and Egger's test detected no significant publication bias. Our estimates (in sensitivity analyses) were rendered nonsignificant when International Index of Erectile Function definition was used and when statistical adjustment was made only for age. Meta-analysis of cross-sectional studies yielded a protective association of alcohol on ED, but the two cohort studies did not demonstrate any significant findings for alcohol consumption. More research is needed to confirm whether alcohol is protective or is unrelated to ED development.

Association between smoking, passive smoking, and erectile dysfunction: results from the Boston Area Community Health (BACH) Survey

INTRODUCTION

Although previous studies report an association between erectile dysfunction (ED) and smoking, few have examined the impact of passive smoke exposure on ED. This analysis examines the association of active and passive smoking and ED and investigates a dose-response effect of smoking.

METHODS

The Boston Area Community Heath (BACH) survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2301 men, aged 30-79 yr, from the city of Boston. ED was assessed using the five-item International Index of Erectile Function. Smoking and passive smoking were assessed by self-report. Analyses adjusted for sociodemographic and lifestyle factors and important chronic illnesses.

RESULTS

An association between smoking and ED was observed with a significant trend in increased risk of ED with cumulative pack-years of smoking (adjusted odds ratio [OR]=1.68; 95% confidence interval [CI], 1.03, 2.30 for > or =20 pack-years). Compared to never smokers not exposed to passive smoking, men who never smoked but were exposed to passive smoking had a moderate, statistically nonsignificant, increase in risk of ED (adjusted OR=1.33; 95%CI: 0.69, 2.55) comparable to the OR observed for a cumulative exposure of 10-19 pack-years of active smoking (adjusted OR=1.25; 95%CI, 0.68, 2.30).

CONCLUSIONS

Results indicate a dose-response association between smoking and ED with a statistically significant effect observed with > or =20 pack-years of exposure. Passive smoking is associated with a small, statistically nonsignificant increase in risk of ED comparable to approximately 10-19 pack-years of active smoking.

Physical activity and erectile dysfunction: meta-analysis of population-based studies

We searched for population-based cross-sectional studies, cohort studies and randomized controlled trials (RCTs) on erectile dysfunction (ED) through Medline, PubMed, PsychInfo and scanned though reference lists. Studies that did not include adjusted odds ratios (OR) of physical activity were excluded. Seven cross-sectional studies were suitable for meta-analysis, and the results from one cross-section study, two cohort studies and one RCT were summarized. Pooling the ORs using random effects models, we derived summary estimate for adjusted OR of physical activity in those with ED compared with those without ED, which was 0.53 (0.31, 0.91). Moderate and high physical activities were associated with a lower risk of ED, with ORs at 0.63 (0.43, 0.93) and 0.42 (0.22, 0.82), respectively. Funnel plot by visual inspection, and Begg's test and Egger's test did not detect significant publication bias. Sensitivity analyses revealed that the summary estimate from the random effects model was robust to changes in study sample size and level of statistical adjustment, but not so robust to changes in ED definition, although the summary estimate for each ED definition did not differ significantly. Although causality cannot be demonstrated from cross-sectional studies, the apparent 'protective' effect of physical activity on ED should be further investigated using large-scale cohort studies or RCTs.