Prostate and sexuality: An overview

Prevalence and Reasons for the Absence of Vaginal Intercourse in Chinese Middle-Aged and Elderly Men

INTRODUCTION

As the global population ages, research on the health of middle-aged and elderly men has intensified.

AIM

To report a paucity of data on the prevalence, etiology, and risk factors associated with lack of vaginal intercourse in middle-aged and elderly Chinese men.

METHODS

Between January, 2018, and May, 2020, 6,096 men aged 40-90 years old who reside in mainland China were included in the community-based study. Validated scales related to erectile dysfunction (EHS and IIEF-5) and late-onset hypogonadism (ADAM and AMS), and in-person interview method were used to collect data. Multivariable analysis was performed to examine the risk factors associated with the absence of intercourse.

OUTCOMES

Prevalence estimate of no current vaginal intercourse and its associations with basic factors and medical comorbidities. Reasons for no current vaginal intercourse.

RESULTS

The prevalence of intercourse absence was 19.8% (95% CI; 18.8-20.8%) in middle-aged and elderly Chinese males, and this proportion was significantly higher in older age groups (8.6%, 11.5%, 24.1%, and 34.2% for men aged 40-49, 50-59, 60-69, and 70-90, respectively; P < .05). Among the men who attributed the lack of intercourse to themselves, 168 (21.4%, 95% CI; 18.7-24.4%) had erectile problems and were apprehensive about erectile failure during intercourse. Strained spousal relationships (35 men, 8.4%, 95% CI; 6.1-11.4%), marital issues (163 men, 39%, 95% CI; 34.4--43.8%), and poor health of the partner (179 men, 42.8%, 95% CI; 38.2-47.6%) were described as reasons for lack of intercourse with spouses. Same risk factors were also found in the multivariate analysis.

CLINICAL IMPLICATIONS

Modifiable factors that are related to lack of intercourse may be beneficial to Chinese middle-aged and elderly men.

STRENGTH & LIMITATIONS

The main strength of the study is that it involved real-world settings. The limitations are as follows. Firstly, psychological data, data on sexual frequency and data regarding types of sex other than vaginal intercourse were not recorded. Secondly, this is a cross-sectional study, from which definite or causative conclusions can't be drawn. Thirdly, the spouses of the participants were not included in the study, and hence the data represent the perceptions of males only. Finally, objective data are required.

CONCLUSION

Modifiable factors related to both the patients and their partners were associated with an increased rate of no intercourse in Chinese middle-aged and elderly men. Guidance for sexual life may benefit men with an absence of intercourse. Future studies are warranted to reexamine our findings. Lu Y, Zhang J, Ma C, et al. Prevalence and Reasons for the Absence of Vaginal Intercourse in Chinese Middle-Aged and Elderly Men. Sex Med 2022;10:100511.

Evaluation of the impact of dutasteride/tamsulosin combination therapy on libido in sexually active men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH): A post hoc analysis of a prospective randomised placebo-controlled study

AIMS

Five-α reductase inhibitor (5ARI) therapy has been associated with sexual dysfunction in some patients. This study assessed the impact of a fixed-dose combination of the 5ARI dutasteride 0.5 mg and the α₁ -adrenoceptor antagonist tamsulosin 0.4 mg (DUT-TAM FDC) on Men's Sexual Health Questionnaire (MSHQ) domain scores in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH).

METHODS

This was a post hoc analysis of a double-blind, randomised, placebo-controlled, parallel-group, multicentre study in sexually active patients, aged ≥50 years, with a confirmed clinical diagnosis of BPH. Sexual activity, sexual desire, and bother domain scores of the MSHQ were assessed at baseline and at Months 1, 3, 6, 9, and 12. Correlation between MSHQ sexual activity/desire scores and ejaculation, erection, and satisfaction domains at baseline was also evaluated.

RESULTS

In the intent-to-treat population (N = 489), 243 and 246 patients were randomised to DUT-TAM FDC and placebo groups, respectively. Compared with placebo, DUT-TAM FDC therapy resulted in statistically significant reductions (worsening) from baseline in adjusted mean MSHQ sexual activity and bother domain scores at Months 1, 3, 6, 9, and 12 (all P < 0.05) and in adjusted mean MSHQ sexual desire domain scores at Months 6, 9, and 12 (all P < 0.05). Significant moderate correlations in the expected direction were observed at baseline between the sexual activity/desire domains and the ejaculation, erection, and satisfaction domains (P < 0.0001).

CONCLUSIONS

These findings help clarify the degree and impact of libido changes in sexually active men treated with DUT-TAM FDC and may support clinical decision-making.

Use of the UPOINT Classification in Turkish Chronic Prostatitis or Chronic Pelvic Pain Syndrome Patients

OBJECTIVE

To determine the positive subdomain numbers and distribution of the UPOINT classification in chronic prostatitis and to compare the erectile dysfunction (ED) pattern.

MATERIALS AND METHODS

From 2008 to 2013, 839 patients with symptomatic chronic prostatitis or chronic pelvic pain syndrome were included in this study. The correlation between UPOINT domains and National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) total score, subscores, and the 5-item International Index of Erectile Function scores were evaluated retrospectively.

RESULTS

The mean patient age was calculated as 37.7 ± 7.4 (range 21-65). The average total NIH-CPSI score was determined as 9.07 (range 1-40) and the average positive UPOINT subdomain number was determined as 2.87 ± 0.32 (range 1-6). Subdomain patient numbers and rates were calculated as 529 urinary (63%), 462 psychosocial (55%), 382 organ specific (45%), 290 infection (34%), 288 neurological or systemic (34%), and 418 tenderness (skeletal muscle) (50%), respectively. It was determined that ED, determining the subdomain of sexual dysfunction in patients, was positive in a total of 326 (39.9%) patients, with 220 patients having mild (26.2%), 76 mild to moderate (9.1%), 19 moderate (2.3%), and 5 with severe (0.6%) ED. A statistically significant correlation was not determined between the 5-item International Index of Erectile Function score and UPOINT subdomain number and NIH-CPSI score.

CONCLUSION

It has been determined that although there is a strong and significant correlation between UPOINT classification and NIH-CPSI score in Turkish patients with chronic prostatitis or chronic pelvic pain syndrome, the inclusion of ED as an independent subdomain to the UPOINT classification is not statistically significant.

Chlamydia trachomatis infection is related to premature ejaculation in chronic prostatitis patients: results from a cross-sectional study

INTRODUCTION

Chronic bacterial prostatitis (CBP) is reported to be a common finding in men with acquired premature ejaculation (PE). The impact of different pathogens on PE development in chronic prostatitis patients is, however, unknown.

AIM

To assess a possible link between CBP caused by Chlamydia trachomatis (Ct) and PE.

METHODS

A consecutive series of 317 patients with clinical and instrumental diagnosis of CBP due to Ct was enrolled (group A) and compared with data obtained from a control group of 639 patients with CBP caused by common uropathogen bacteria (group B). Prostatitis symptoms were investigated with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), while the ejaculatory status of patients was assessed using the PE Diagnostic Tool (PEDT).

MAIN OUTCOME MEASURES

All participants were asked to complete the NIH-CPSI, the International Index of Erectile Function-15 erectile function domain (IIEF-15-EFD), the PEDT, and the Short Form (SF)-36 questionnaires.

RESULTS

Patient groups A and B had comparable scores of NIH-CPSI (P = 0.07), IPSS (P = 0.32), and IIEF-15-EFD (P = 0.33) tests. PE was assessed in 118 patients in group A (37.2%) and in 73 subjects in group B (11.5%). The two groups are different in terms of PE prevalence (P < 0.0002). Compared with group B, group A showed significantly higher scores of the PEDT test (11.3 [±2.6] vs. 4.5 [±2.9], P < 0.0001) and lower scores of the SF-36 tool (96.5 [±1.1] vs. 99.7 [±1.3], P < 0.0001). In our multivariate model assessment, being positive for a Ct infection marker was independently associated with the PEDT score even after adjusting for age, smoking habit, body mass index, and education level (adjusted odds ratio = 3.21; 95% confidence interval: 2.02-4.27; P < 0.003).

CONCLUSIONS

Patients affected by CBP due to Ct infection reported higher prevalence of PE and lower quality of life when compared with patients affected by CBP caused by traditional uropathogenic bacteria.

Prostatic disease and sexual dysfunction

Prostatitis and benign prostatic hyperplasia (BPH) are common prostatic diseases. Furthermore, the incidence of prostate cancer has recently shown a rapid increase, even in Korea. Pain caused by prostatitis may induce sexual dysfunction, including erectile dysfunction and ejaculatory disturbance. And BPH itself, or treatments for BPH, may affect sexual function. In addition, with increased detection of localized prostate cancer, surgical treatments and radiation therapy have also increased, and the treatments may cause sexual dysfunction. Aging is also an important factor in the deterioration of the quality of life of men. Deterioration of quality of life caused by prostate diseases may be affected not only by the prostate diseases themselves but also by the sexual dysfunction caused by the prostate diseases secondarily. Thus, consideration of these points at the time of treatment of prostate disease is required. Therapies suitable to each condition should be selected with an understanding of the close association of prostate diseases and associated sexual dysfunction with the quality of life of males.

Inclusion of erectile domain to UPOINT phenotype does not improve correlation with symptom severity in men with chronic prostatitis/chronic pelvic pain syndrome

OBJECTIVE

To evaluate the addition of an erectile dysfunction (ED) domain to the UPOINT (Urinary, Psychosocial, Organ-specific, Infection, Neurologic/systemic, and Tenderness) system in our patients. The UPOINT system classifies men with chronic prostatitis/chronic pelvic pain syndrome into 6 domains. The domain number correlates with the symptom severity, and UPOINT-guided therapy has been shown to significantly improve symptoms. This was recently confirmed in a large Italian cohort, but was only true in a German cohort if an ED domain was added ("S," resulting in "UPOINTS").

METHODS

A total of 100 recent patients with chronic prostatitis/chronic pelvic pain syndrome were classified using the UPOINT system. An additional "S" domain was retrospectively added for men with bothersome ED. Symptom severity was assessed using the National Institutes of Health Chronic Prostatitis Symptom Index.

RESULTS

The "S" domain was positive in 28% of the patients. A stepwise positive correlation was found between the number of positive UPOINT domains and symptom severity (Pearson r=.27, P=.006). The "S" domain reduced this correlation (Pearson r=.25, P=.01). ED had no effect on the total Chronic Prostatitis Symptom Index (24.8 vs 24.7) or on the subscores for pain (11.5 vs 11.6) or quality of life (8.8 vs 8.9). On multivariate analysis, the number of UPOINT domains was the strongest predictor of the total Chronic Prostatitis Symptom Index (relative increase 4.1, 95% confidence interval 1.5-6.7, P=.002), a relationship lost with UPOINTS (relative increase 1.0, 95% confidence interval -2.1-4.2, P=.53).

CONCLUSION

In our patients, ED did not independently affect the chronic pelvic pain syndrome symptom severity or quality of life. Although ED should be elicited and appropriately treated in men with chronic prostatitis/chronic pelvic pain syndrome, our data do not support the utility of using ED as an independent UPOINT domain.

Lower urinary tract symptoms and sexual dysfunction: an audit of sexual symptoms among patients attending a nurse-led prostate clinic

Significant numbers of men with lower urinary tract symptoms (LUTS) also report symptoms of sexual dysfunction (SD). The prevalence of SD in patients referred to a prostate assessment clinic, was assessed using a confidential questionnaire. Fifty-six percent of patients reported difficulties in maintaining an erection and 48% felt that improving their sexual function would benefit their quality of life. None of the referral letters from primary care mentioned symptoms of SD. Patients with LUTS seen in primary and secondary care should be assessed for SD and offered appropriate advice and management.

Prevalence of premature ejaculation and its correlation with chronic prostatitis in Chinese men

OBJECTIVES

Chronic pelvic pain syndrome is a common and serious health problem affecting the quality of life of men. We evaluated the prevalence of premature ejaculation (PE) in Chinese men with chronic pelvic pain syndrome and studied its correlation to chronic prostatitis.

METHODS

A total of 15,000 men (aged 15-60 years) were randomly recruited to take part in a survey to provide questionnaire-elicited information for sociodemographics, sexual function, National Institutes of Health-Chronic Prostatitis Symptom Index, and International Index of Erectile Function 5-item questionnaire. The eligible subjects of the present investigation were married with sexual activity.

RESULTS

Responses were collected from 12 743 men (84.95%). Of these men, 1071 (8.4%) reported having prostatitis-like symptoms. The incidence of chronic prostatitis was 4.5% (n = 571) for the entire group. Of the 7372 eligible men, the incidence of prostatitis-like symptoms, chronic prostatitis, and PE was 10.5% (n = 771), 5.0% (n = 370), and 15.3% (n = 1127), respectively. The group with PE had worse National Institutes of Health-Chronic Prostatitis Symptom Index scores (P < .05) and lower International Index of Erectile Function 5-item questionnaire scores (P < .05) than the patients without PE. Also, the percentage of prostatitis-like symptoms in the PE group was greater than that in the non-PE group (P < .05). The prevalence of PE was 64.1% and 36.9% in the prostatitis-like symptom and chronic prostatitis group, respectively, of the 7372 eligible men.

CONCLUSIONS

The results of our study showed a high prevalence of PE in patients with chronic prostatitis. An examination of the prostate, physically and microbiologically, should be considered during the assessment of patients with PE.

Clinical study of the efficiency and safety of afala in patients with benign prostatic hyperplasia

The use of afala in patients with benign prostatic hyperplasia and moderate urination disturbances reduced the symptoms of the disease, improved urodynamic parameters, and increased quality of life. Clinical efficiency of afala was comparable with the efficiency of Serenoa repens extract (reference preparation).

Sexual dysfunction and prostatitis

Despite a large number of reports exploring the links between diseases of the prostate and effects on sexuality, the relationship between prostatitis and sexual dysfunction has not been as thoroughly investigated. A number of reports have focused on the adverse effects of prostatitis on quality of life, with resultant indirect effects on sexuality. More detailed studies are available on the links between ejaculation and the chronic prostatitis/chronic pelvic pain syndrome subgroup of prostatitis. Improvement of sexual dysfunction following treatment of prostatitis has been reported in a few studies, most notably in association with alpha-blocker therapy. This review addresses some of the more relevant reported links between prostatitis and sexual function.

Sexual dysfunction in the patient with prostatitis

Prostatitis (chronic prostatitis/chronic pelvic pain syndrome ) is a common condition in men that accounts for a significant number of visits to a medical doctor or urologist. It is one of the most widely diagnosed conditions in men who attend urologic clinics. Erectile dysfunction, defined as the consistent inability to obtain and/or maintain a penile erection sufficient for adequate sexual relations, also is a common problem. This review explores the links between sexual dysfunction and prostatitis. Most of the data linking lower urinary tract symptoms and erectile dysfunction suggest that lower urinary tract symptoms impair the overall quality of life and that a low quality of life contributes to or causes erectile dysfunction. Prostatitis-like symptoms such as perineal, penile, and suprapubic discomfort or pain during or after ejaculation and voiding complaints such as irritative and obstructive voiding symptoms (urinary frequency, urgency, and dysuria) may affect the global emotional well-being of a man. Erectile dysfunction also is strongly associated with a negative impact on the quality of life. The available literature demonstrating the influence of CP/CPPS on the incidence of erectile dysfunction is scant. From the literature, it is known that lower urinary tract symptoms and benign prostatic hyperplasia are definitely related to erectile dysfunction. Any kind of pain is likely to be the most significant symptom in men with CP/CPPS as it relates to sexual dysfunction. Sexual dysfunction such as ejaculation discomfort is described as a symptom of CP/CPPS. Most of the data linking the two suggest that CP/CPPS impairs the overall quality of life and it is this that contributes to or causes erectile dysfunction.

REVIEWS: Sexual Health Inquiry and Support Is a Primary Care Priority

The World Health Organization defines sexual health as "a state of physical, emotional, mental and sexual well-being related to sexuality." This broad definition goes beyond simply inquiring about sexual dysfunction and ideally fits the model of patient-centered primary care. As we observe that sexual health and physical health are often closely related, discussions about sexual activity can be very revealing. Sexual intimacy appears positively related to loving relationship satisfaction and stability. Sexual problems have a clear negative impact on both the quality of life and emotional state regardless of age. Learning about specific sexual dysfunctions among men can reveal a variety of as-yet-undiagnosed comorbid pathologic conditions such as: (i) depression and other emotional illnesses; (ii) psychosocial stress; (iii) actual cardiovascular disease as well as related risk factors such as hypertension, diabetes, and/or hyperlipidemia; (iv) hyperprolactinemia; and (v) low serum testosterone. Specific sexual dysfunctions among women can reveal pathologic conditions such as: (i) depression and other adverse imitational and psychosocial conditions; (ii) low serum estrogen or testosterone; and/or (iii) vaginal or pelvic disorders. A discussion about sexual health can be accomplished efficiently in a primary care office with the inquiring clinician having the option to deal with any sexual problems and dysfunctions directly, or to refer the patient to an appropriate specialized care source.

Sexual dysfunction in the patient with prostatitis

PURPOSE OF REVIEW

Prostatitis [chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)] is a common condition in men that accounts for a significant number of visits to a medical doctor or urologist. It is one of the most widely diagnosed conditions in men attending urologic clinics. Erectile dysfunction, defined as the consistent inability to obtain and/or maintain a penile erection sufficient for adequate sexual relations, is also a common problem. This review explores the links between sexual dysfunction and prostatitis.

RECENT FINDINGS

Most of the data linking lower urinary tract symptoms and erectile dysfunction suggest that lower urinary tract symptoms impair the overall quality of life and that a low quality of life contributes to or causes erectile dysfunction. Prostatitis-like symptoms such as perineal, penile, and suprapubic discomfort or pain during or after ejaculation and voiding complaints such as irritative and obstructive voiding symptoms: urinary frequency, urgency, and dysuria may affect the global emotional well-being of a man. Erectile dysfunction is also strongly associated with a negative impact on the quality of life.

SUMMARY

The available literature demonstrating the influence of CP/CPPS on the incidence of erectile dysfunction is scant. From the literature, it is known that lower urinary tract symptoms and benign prostatic hyperplasia are definitely related to erectile dysfunction. Any kind of pain is likely to be the most significant symptom in men with CP/CPPS as it relates to sexual dysfunction. Sexual dysfunction like ejaculation discomfort is described as a symptom of CP/CPPS. Indeed, most of the data linking the two suggest that CP/CPPS impairs the overall quality of life and it is this that contributes to or causes erectile dysfunction.

Selecting therapy for maintaining sexual function in patients with benign prostatic hyperplasia

In the first of these mini-reviews the selection of therapy for the maintenance of sexual function in patients with BPH is outlined, along with an explanation of how altered regulation of neurotransmitters, especially noradrenaline, may underlie the syndrome of LUTS and sexual dysfunction. Other mini-reviews outline the current status of robotic surgery to treat renal and adrenal disorders, and its future applications, and the potential use of the nitric oxide/cGMP pathway as a potential target to treat BOO associated with benign prostatic enlargement. Finally, the capacity to be creative in academic departments is extolled as a core property of academicians, and its surfacing described as having the potential to revitalize individuals and departments.

Enlarging the scope of managing benign prostatic hyperplasia: addressing sexual function and quality of life

Benign prostatic hyperplasia is a common genitourinary disorder that increases in incidence with age. Symptoms of this condition include a weak urinary stream, hesitancy, intermittency and sensations of incomplete emptying, as well as frequency, urgency, urge incontinence and nocturia. These symptoms can be ameliorated successfully by a variety of medical treatments - such as alpha(1)-adrenergic blockade and 5-alpha-reductase inhibition - and surgical therapies - including transurethral resection of the prostate and less-invasive procedures. However, many of the treatments are known to result in sexual dysfunction, which can have a negative impact on the patient's quality of life. This must be considered when the physician seeks to determine the appropriate treatment for an individual patient. Current reports suggest that alpha(1)-adrenergic blockade is most likely to improve lower urinary tract symptoms while resulting in the fewest sexual side-effects; 5-alpha-reductase inhibitors appear to be particularly appropriate in men with large prostates. Among surgical therapies, transurethral resection of the prostate remains the gold standard, but is associated with a high incidence of sexual side-effects, especially retrograde ejaculation. Transurethral incision of the prostate, which is an endoscopic procedure, may be as effective as transurethral resection, but results in fewer side-effects. Minimally invasive procedures, including laser ablation or resection of the prostate, transurethral microwave thermotherapy and transurethral needle ablation, are rapidly evolving technologies that have demonstrated promising results, at least in the short term.

Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical "Aging Male" symptoms? Results of the "Cologne Male Survey"

OBJECTIVES

Due to demographic developments in industrial nations, age-correlated diseases are becoming more important. From many epidemiological studies we know that the prevalence of benign prostatic hyperplasia (BPH) and the loss of erectile function (= erectile dysfunction or ED) increase with advancing age. Are these two illnesses related or/and independent?

METHODS

We mailed our newly developed and validated questionnaire on male erectile dysfunction (KEED), as well as a set of questions pertaining to voiding problems (IPSS), to a representative population sample of 8000 men from 30 to 80 years of age residing in the city of Cologne.

RESULTS

The responses included 4489 evaluable replies (56.1%). The response rates in the different age groups ranged from 41 to 61%. The mean age of the men who answered was 51.8 years. The overall prevalence of ED was 19.2% (n=862), with a steep age-related increase from 2 to 53%. Furthermore, 31.2% (n=1957) of all men complained of lower urinary tract symptoms (LUTS), the prevalence and the intensity of which increased with age. Interestingly, a high co-morbidity was found between ED and voiding problems. Prevalence of LUTS in men suffering from ED was about 72.2% (n=621) vs. 37.7% (1367) in men with normal erections. The odds ratio was evaluated with 2.11. The trivariate analysis showed that the occurrence of LUTS can be considered as an age-independent risk factor for the development of ED (p<0.001).

CONCLUSIONS

Even though the pathogenetic relationship between LUTS and ED is not yet completely understood, one has to postulate a direct association between these two typical symptom complexes in the aging male.

Prevalence of erectile dysfunction and associated factors among men without concomitant diseases: a population study

We interviewed a population sample of 2412 men aged 40-70 y in Brazil, Italy, Japan and Malaysia about medical history, lifestyle habits and sexual behavior. Men were classified as having moderate or complete erectile dysfunction (ED) if they reported to be sometimes or never able to achieve and maintain an erection satisfactory for sexual intercourse, respectively. There were 1335 men with no diagnosis of cardiovascular or prostate diseases, diabetes, ulcer or depression, nor taking hormones. The prevalence of ED was 16.1%. ED was associated with age (the risk increased 8% per y), moderate (odds ratio (OR)=2.2) or severe (OR=4.9) lower urinary tract symptoms and smoking (OR=2.3 for >30 cigarettes/day). It was inversely associated with physical activity (OR=0.5) and higher educational levels. Between the ages of 40 and 70 y, almost one in six 'healthy' men is affected by ED. Further research should look at preclinical disease stages and genetic factors.

Symptomatic benign prostate hyperplasia: impact on partners' quality of life

OBJECTIVES

Symptomatic benign prostate hyperplasia (BPH), besides affecting patients' quality of life through lower urinary tract symptoms (LUTS), and related acute events, may affect their partners' quality of life as well. The present study was focused on exploring partner morbidity in cases of symptomatic BPH patients being evaluated for surgical treatment.

METHODS

The study group was comprised of 50 couples where male partners suffered from symptomatic BPH and was referred for further evaluation and, possibly, surgical treatment. Male subjects were asked to fill out the IPSS form, while the female partners were, separately, asked to fill out another structured questionnaire about 7 items (sleep disturbance, social disruption, performance of essential tasks, psychological impact, sex life, fear of cancer, fear of surgery). Data were analyzed in relation to the severity of symptoms (IPSS), patient's and partner's age, couple's age difference, marriage duration, mode and place of living.

RESULTS

Partners' morbidity due to their husband's condition was comprised of sleep disturbance (28%); disruption of social life (30%) positively related to IPSS and negatively to the symptom duration; inability to take care of essential tasks outside and inside their house (8%); psychological burden (66%) positively related to the wife's age, the couple's age difference and the marriage duration; inadequate sex life (48%); fear of prostate cancer (62%); and fear of surgery (82%).

CONCLUSIONS

Partners of patients with symptomatic BPH experience significant morbidity because of their husband's condition. The severity of patients' symptoms, however, is not always related to partners' morbidity. Partners should be adequately informed of the benign nature of the disease, as well as, the possible operating risks.

Sexual activity, sexual and partnership satisfaction in ageing men--results from a German representative community study

Age-related changes in men have only recently received widespread scientific attention. Although a reduction in sexual interest and satisfaction are common in the 'ageing male', little is known about sexual activity and satisfaction in the general population. We therefore investigated age-related changes in men's sexual activity, and their sexual and partnership satisfaction. We also tried to identify psychosocial determinants of sexual and partnership satisfaction. A representative community-based sample of 1299 men between 18 and 92 years was interviewed, based on a set of standardised questionnaires, on life satisfaction, physical complaints, personality and interpersonal problems. Comparing the 3 age groups (18-40, 41-60, 61-92 years), we found the proportion of sexually active men to be fairly constant up to the age of 60 (84-85%); while above the age of 60, the proportion declined to 51%. The proportion of men without a partner (32% of the total sample) who were sexually active was lower; in this group sexual activity started to decline between 41 and 60 years (from 74% to 56%), and comparably fewer older men without a partner were sexually active (17%). We also found an age-related decline in sexual satisfaction, and a slight increase in partnership satisfaction. Sexual activity was a major determinant of sexual satisfaction; sexual and partnership satisfaction were compromised in men who were dissatisfied with their health, and reported somatoform complaints and interpersonal problems. Our results emphasise the contribution of psychosocial factors to declining sexual activity and satisfaction. Future studies in the ageing male should take account of existence and quality of a partnership, and recent sexual activity.

Complaints of the ageing male based on a representative community study

OBJECTIVES

To determine (a) the relationship between physical and somatoform complaints, distress and life satisfaction and ageing in the male community and (b) their psychosocial determinants.

METHODS

Two stratified random samples of the German male population (total of 2,182 men) were investigated by standardised questionnaires of complaints (MFI-20, GBB), distress (HADS) and life satisfaction.

RESULTS

When participants were grouped into six age groups (18-30, 31-40, 41-50, 51-60, 61-70, >70 years), we found a continuous increase of physical, mental and general fatigue, and a reduced activity and motivation associated with age. Exhaustion, cardiovascular and musculoskeletal complaints also increased. This was accompanied by a reduced health satisfaction and increased depression scores. Marked increases of certain complaints occurred in specific age groups.

CONCLUSIONS

Community data provide important reference points in evaluating the ageing male. Based on regression analyses we could also demonstrate the contribution of psychosocial vulnerability and protective factors to the development of age-related symptoms.

Reproducibility and clinical and concurrent validity of the MSF-4: a four-item male sexual function questionnaire for patients with benign prostatic hyperplasia

INTRODUCTION

The MSF-4 (Male Sexual Function 4-item) questionnaire is a condition-specific four-item scale of men's sexuality. We describe two studies that were conducted to assess the reproducibility and validity of the MSF-4 questionnaire.

METHODS

Study 1 was a Phase III, multicenter study with a double-blind, parallel group design which was conducted in five countries. The objectives were to check the construct validity and factorial structure of the MSF-4 along with internal consistency reliability and clinical validity. Study 2 was a longitudinal, noncomparative, observational multicenter study to assess the reproducibility and the clinical and concurrent validity of the MSF-4.

RESULTS

When exploratory factor analysis was performed with a free number of factors, the variability of the global MSF-4 score was based on a single factor across all countries in Study 1 except Spain. There was a high level of internal consistency reliability (Cronbach's alphas 0.68-0.90) and the MSF-4 was able to significantly discriminate different health states as assessed by the International Prostate Symptom Score (I-PSS) or Quality of Life (QoL) questionnaire. In study 2, there was a significant correlation between the MSF-4 and the International Index of Erectile Function (IIEF) scores (p = .0001 for all items) especially erectile function (correlation coefficient -0.77). The MSF-4 was able to distinguish among patients with differing degrees of benign prostatic hyperplasia (BPH) symptoms as measured by the I-PSS (p = .0001) and between those with and without sexual disorders (p = .0001).

CONCLUSION

The MSF-4 is a psychometrically validated questionnaire with good reproducibility and clinical validity, which allows easy and appropriate assessment of male sexual function in the clinical setting.

Benign prostatic hyperplasia and erectile dysfunction--is there a link?

There is little evidence to support a link between benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Any apparent relationship may reflect the fact that both are common conditions with a similar gender and age distribution. However, the surgical treatment of BPH (e.g. TURP or open prostatectomy) may cause ED as a postoperative complication in some patients. Similarly, the medical treatment of BPH with finasteride may be associated with ED (< 5% in one study). However, alpha-blockade is not associated with this side-effect.