Determinants of male reproductive health disorders: the Men in Australia Telephone Survey (MATeS)

A cross-sectional analysis of the association between screen-based sedentary behavior and erectile dysfunction in US adult males

Despite previous studies, the association between screen-based sedentary behavior (SB) and erectile dysfunction (ED) remains unclear. This study aimed to investigate the relationship between screen-based SB and ED using data from the 2001-2004 National Health and Nutrition Examination Survey (NHANES). A total of 4,047 participants were included, of whom 1,192 (29.5%) had ED. Multivariable logistic regression models were used to analyze this association. After adjusting for potential confounders, screen-based SB exceeding 2 h per day was significantly associated with an increased risk of ED (OR = 1.32; 95% CI, 1.12-1.56; p < 0.0001). Subgroup analysis further confirmed a consistent and independent positive association across different population groups (all p for interaction > 0.05). These findings suggest a significant relationship between prolonged screen-based SB and ED in U.S. adult males. Further prospective studies are needed to confirm these results.

Factors affecting utilization of male sexual and reproductive health services: a qualitative description of males in Anambra State, Southeast Nigeria

INTRODUCTION

The utilization of sexual and reproductive health (SRH) services by males globally is significantly low despite their considerable sexual and reproductive health needs. This study aimed to understand the factors that influence the utilization of male sexual and reproductive health SRH services.

METHODS

We used an explanatory sequential mixed methods research design, with qualitative description to explore the perceptions of males (15-49years) on the utilization of male SRH services in Anambra State, Nigeria. In October 2021, 56 males participated in seven focus group discussions conducted across seven communities. The data were analysed by thematic analysis. A composite narrative was used to report the results.

RESULTS

Males in both urban and rural areas of Anambra State preferred informal health facilities; male-focused health facilities and male health workers. The participants perceived services as costly; and criticized healthcare workers' attitudes. Some rural areas had inadequate SRH facilities, staff and commodities. The participants exhibited varying levels of SRH awareness.

CONCLUSION

To improve male SRH service utilization, clinics should be more male-centric and cost-effective. Healthcare providers require retraining to offer patient-centered care. Additionally, ward development committees should advocate for better staffing and the availability of SRH commodities.

Relationship Between Lifestyle, Health Factors, and Severity of Lower Urinary Tract Symptoms Amongst Men Living in Southeast Nigeria

Background Lower urinary tract symptoms (LUTS) refer to a group of symptoms related to the storage and voiding of urine that comprises storage, voiding, and post-micturition symptoms affecting the lower urinary tract, and the prevalence in men in our society is on the rise as a result of an increase in the life expectancy. This study investigates the relationship between lifestyle, health factors, and severity of LUTS amongst men living in the southeastern part of Nigeria. Method A cross-sectional study of 389 men aged 42-96 years was conducted. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Health factors such as diabetes mellitus, hypertension, age, prostate volume, prostate-specific antigen, body mass index, and others were examined using the chi-square test. Results Out of the 389 participants enrolled in the study, the mean age was 69.21 ± 9.683 years. Nocturia was the most reported symptom in 337 participants. Over half of the respondents (212) experienced severe symptoms, while 152 (39.1%) reported moderate issues, and 25 (6.4%) had mild symptoms. Mean values were as follows: prostate volume of 69.62 ± 34.82 g, post-void residual urine of 52.72 ± 14.96 mL, and prostate-specific antigen (PSA) of 23.42 ± 28.78 ng/mL. Using the chi-square test, significant associations were found between LUTS severity and age (x2=37.454; p≤0.001), diet (x2=16.341; p=0.003), BMI (x2=21.152; p=0.002), diabetes mellitus (x2=7.690; p=0.021), prostate volume (x2=22.001; p≤0.001), and post-void residual urine (x2=10.779; p=0.005). Conclusion This study highlights the importance of socio-demographic characteristics, lifestyle factors, and clinical parameters in predicting LUTS severity. These findings can inform prevention and management strategies for LUTS.

Biological activities of African medicinal plants in the treatment of erectile dysfunction: a mechanistic perspective

The global incidence of erectile dysfunction is increasingly becoming a significant health concern, as its frequency demonstrates a consistent upward trajectory each year. In recent years, FDA-approved drugs like sildenafil among others has been approved to treat this disorder however the drug is not without its own side effects. In a bid to develop alternative therapeutic option, scientists have now turned to traditional medicine in search of a treatment regimen. Africa is blessed with numerous medicinal plants used in the treatment and management of several diseases including erectile dysfunction. Due to limited access to modern medicine and high-quality medical facilities, a significant number of individuals in Africa continue to depend on traditional medicine as a means of addressing critical health issues. Perhaps one of the grossly explored medicinal properties of plants in Africa is for erectile function. Through years of extensive research in medicinal plants, several plants indigenous to Africa have been identified to show profound ability to mitigate erectile dysfunction. While previous reports have indeed corroborated the ability of this plant to abate erectile dysfunction, there is still a dearth of information regarding the mechanistic aspect of these plants. Hence, the current review aims to provide a comprehensive mechanistic perspective to the major African medicinal plant which have been reported to be effective in the treatment of erectile dysfunction.

The bidirectional association between depression and lower urinary tract symptoms (LUTS) in men: A systematic review and meta-analysis of observational studies

BACKGROUND

Recent evidence from observational studies suggests a bidirectional association between lower urinary tract symptoms (LUTS) and depression in men. We sought to systematically quantify the effect of the presence of LUTS on depression symptoms, compared to those without LUTS, in adult males, and vice versa.

METHODS

Electronic databases (MEDLINE, PsycINFO, SCOPUS, Embase) were examined for articles in English before March 2021. Observational studies of men aged over 18 years; reporting an association between LUTS and depression; including a validated scale for LUTS and depression symptoms were eligible for study inclusion.

RESULTS

Seventeen studies out of 1787 records identified 163 466 men with reported depression symptoms by LUTS status, while 10 studies reported 72 363 men with LUTS by depression symptoms. Pooled estimates showed a strong effect of LUTS presence on depression risk (OR: 2.89, 95% CI: 2.50-3.33), with a high degree of heterogeneity among the examined studies (I²  = 83%; τ²  = 0,06; p < 0.001). Subgroup analyses demonstrated differences by study region (Q value:13.7, df:4, p = 0.003), setting (7.8(2), p = 0.020), design (7.2(1), p = 0.003), quality (6.2(1), p = 0.013), and LUTS measure (40.9(3), p < 0.001). Pooled estimates also showed a strong effect of depression presence on LUTS risk in men (OR: 3.13, 95% CI: 2.72-3.60), with only moderate heterogeneity between studies (I²  = 58%; τ²  = 0,02; p = 0.001).

CONCLUSIONS

The strong relationship observed between LUTS and depression implies shared risk factors that cannot be solely attributed to the prostate. This has immediate implications for future studies and the assessment and management of patients with either condition.

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.

Prevalence and predictors of lower urinary tract symptoms in Solomon Islander adult men

Background:

Despite growing interest in the prevention of lower urinary tract symptoms (LUTS) globally and in the Asia-Pacific region, population-based evidence is limited in the smaller Pacific Island countries such as in the Solomon Islands. This study aimed to investigate the prevalence and describe the risk factors associated with moderate to severe LUTS among Solomon Islander men.

Methods:

A cross-sectional survey was conducted among 400 men aged ⩾18 years living in Honiara, Solomon Islands. LUTS were assessed using the International Prostate Symptom Score (IPSS). The association between moderate to severe LUTS and sociodemographic, health conditions and health-related factors were estimated using logistic regression adjusted for age.

Results:

Overall, 13.8% reported moderate LUTS, and 0.8% reported severe LUTS. Frequent night-time urination was the most commonly reported LUTS. The adjusted odds of moderate to severe LUTS decreased with increasing level of education. The odds increased among men reporting elevated psychological distress, increased stressful events in the past 12 months and depression.

Conclusions:

About one in six Solomon Islander men experience moderate to severe LUTS, having a negative impact on their mental health and general well-being.

Study of the risk factors of erectile dysfunction and phospho diestrase type 5 inhibitors usage among Egyptian population with erectile dysfunction: A cross-sectional survey

OBJECTIVES

We aimed to study the risk factors of erectile dysfunction (ED) and different patterns of phosphodiestrase type 5 inhibitors (PDE5is) usage among Egyptian patients.

PATIENTS AND METHODS

One thousand five hundred consecutive Egyptian patients complaining of ED were included in this cross-sectional study from July (2014) to October (2015). Patients were requested to answer the international index of erectile function questionnaire (IIEF-5). Statistical differences between groups were tested using Chi square test and Spearman's rho correlation coefficient for qualitative variables.

RESULTS

Remarkably, significant associations between IIEF scores and aging and diabetes mellitus (DM) and hypertension (HTN) and ischaemic heart disease (IHD) and hyperlipidaemia were shown in the studied patients (p<.0001, p<.0001, p<.0001, p<.0001, p<.0001, respectively). Eventually, our study showed significant correlations between different age groups and morning erection and lower urinary tract symptoms and HTN and IHD and DM where the severity of ED was directly proportional to the absence or decreased strength of morning erection with aging and the increased incidence of LUTS and HTN and IHD and DM with aging (p<.0001; p=.001; p<.0001; p<.0001; p<.0001, respectively).

CONCLUSION

Our study demonstrated that aging; DM, HTN and hyperlipidaemia are potential major risk factors of ED in Egypt for further validation. In addition, most of the participants used PDE5is without prior medical consultation together with concomitant administration of illicit drugs.

Associations between body mass index, waist circumference and erectile dysfunction: a systematic review and META-analysis

Growing evidence reports that obesity might play a role in erectile dysfunction (ED), but limited knowledge is available. We conducted a meta-analysis to estimate the prevalence of ED in overweight men and men with obesity. We performed a systematic review up to 01/04/2019 to investigate the associations between obesity and ED. Applying a random-effect model, we calculated the prevalence of ED, the odds ratio (OR) for the presence of ED by Body Mass Index (BMI) categories and the mean differences between ED and controls in BMI and Waist Circumference (WC). Among 3409 studies, we included 45 articles with 42,489 men (mean age = 55 years). Taking normal weight men as reference, the prevalence of ED was significantly higher in overweight (OR = 1.31; 95%CI: 1.13-1.51; I² = 72%) and in men with obesity (OR = 1.60; 95%CI: 1.29-1.98; I² = 79%). Adjusting our analyses for potential confounders, the results were confirmed in men with obesity (OR = 1.46; 95%CI: 1.24-1.72; I² = 72%). ED was associated with significant higher values of BMI (MD = 0.769; 95%CI: 0.565-0.973 Kg/m²; I² = 78%) and WC (MD = 5.251 cm; 95%CI: 1.295-9.208; I² = 96%). Considering the high prevalence of ED among men with obesity, clinicians should screen for this clinical condition in this population. Findings from the present study suggest that reducing adiposity is a crucial approach in patients with ED who are affected by obesity.

Designing and psychometric of reproductive health related behaviors assessment tool in Iranian males: an exploratory mixed method study protocol

BACKGROUND

Male reproductive health is a relatively new concept, and most men are neglected in reproductive health discussions. Therefore, it appears that there is insufficient information about the male reproductive health. This study aims to design a psychometric instrument for assessing the male reproductive health-related behavior.

METHODS/DESIGN

This is a sequential exploratory mixed-method study with a classical instrument development design. It will be conducted in two qualitative and quantitative phases on the studied units including the men living in Tehran. In the first phase, a qualitative study of a contractual content analysis approach will be conducted in order to perceive the concept of male reproductive health-related behavior, determine the dimensions of the questionnaire, and explore the items. In the second phase, a quantitative study will be carried out to evaluate the psychometric properties as well as (form, content, and construct) validity and reliability of the instrument designed in the first phase. Finally, the instrument will be scored and interpreted.

DISCUSSION

Discovering men's perception of concept of reproductive health-related behavior can help design a valid and reliable questionnaire which can be used in studies evaluating the male reproductive health-related behavior.

ETHICAL CODE

IR.TUMS.FNM.REC.1397.157.

An investigation of the relationship between physical fitness, self-concept, and sexual functioning

BACKGROUND

Obesity and inactivity have led to an increasing number of individuals with sexual dysfunctions (43% of women; 31% of men). Small bouts of exercise can drastically improve sexual functioning. Thus, the present study is designed to examine the effects of physical fitness and self-concept on sexual functioning.

MATERIALS AND METHODS

Fitness assessments and questionnaires were administered to 133 participants between the ages of 18 and 50 years. Physical fitness was assessed through body composition, cardiovascular endurance, muscular strength, and muscular endurance. Self-concept was presented as a total self-concept score and as six individual concepts of self. Sexual function was presented as both an aggregate score and five separate constructs of sexual functioning - fantasy/cognition, arousal, orgasm, behavior/experience, and drive/desire.

RESULTS

The results indicated that sexual behavior/experience was predicted by body fat percentage. In men, fantasy was related to total self-concept; sexual behavior/experience was related to likeability. In women, arousal was predicted by cardiovascular endurance. Total self-concept was related to both orgasm and sex drive/desire. Power and muscular strength were significantly related to number of sexual partners in women but not men.

CONCLUSIONS

The present study adds to the growing body of evidence indicating a positive relationship between physical fitness and sexual health. Individuals with sexual dysfunctions, particularly women, who are not persuaded by the currently publicized benefits of physical activity, may be inclined to exercise to improve sexual functioning.

The Australian longitudinal study on male health-methods

BACKGROUND

The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development.

METHODS

Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use.

RESULTS

A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %.

CONCLUSION

Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects.

Survey of knowledge, attitude, and practice regarding reproductive health among urban men in China: a descriptive study

There has been little focus on men's reproductive health (RH) in China. This descriptive study conducted in Yiling District, Yichang, China, surveyed male knowledge of sexual physiology and RH to assess levels of knowledge, attitudes and practices (KAPs) regarding prevention of sexually transmitted diseases (STDs). A total of 3933 men, aged 18–59 years (mean, 40.3 years), were recruited by cluster random sampling. They completed a questionnaire in the presence of an interviewer, with items related to subject characteristics, RH knowledge, and subjective symptoms of the reproductive system. Physical examination and reproductive system disease diagnosis were performed. Participants’ occupations were predominantly skilled labor (80.5%). Nearly four-fifths (78.5%) respondents had at least one reproductive disease. Over half of respondents were aware of and declared a positive attitude about sexual physiology and safe sex, and 70% of them selected to visit a doctor when they had a reproductive disorder. However, only 41.9% believed human immunodeficiency virus/acquired immunodeficiency syndrome could be transmitted through breastfeeding, and 64.6% incorrectly thought they could avoid contracting STDs by cleaning their genitals after intercourse. In addition, 45% discriminated against and were unwilling to be friends with infected persons. Nearly 45% of those with a reproductive system disorder refused to discuss it with friends or family members. These results indicate that this cohort of Chinese men had a certain degree of KAP about RH, whereas some aspects require further public health education in the general population. It is necessary to disseminate accurate knowledge of STD risk in China based on sociodemographic characteristics.

The Circle of Lifestyle and Erectile Dysfunction

INTRODUCTION

Erectile dysfunction (ED) has been significantly associated with many chronic conditions including obesity, the metabolic syndrome, hypogonadism, diabetes mellitus, cardiovascular disease (CVD), lower urinary tract symptoms, and psychiatric/psychological disorders. ED is also a well-established predictor of CVD.

AIM

This review will focus on the association of ED with cardiovascular, metabolic, and cognitive conditions and discuss the effects of managing lifestyle factors in order to reduce the burden of ED and consequently outcomes in patients with chronic conditions.

METHODS

A literature search using Medline, PubMed (U.S. National Library of Medicine and the National Institutes of Health), and abstracts from scientific meetings was performed from 1990.

MAIN OUTCOME MEASURES

Main outcome measures were improvements in sexual function.

RESULTS

A total of 59 reviews on the topic were evaluated.

CONCLUSIONS

Targeting several lifestyle factors associated with CVD/metabolic/cognitive disorders, e.g., smoking, alcohol consumption, obesity, and physical activity, can have significant benefits, leading to an improvement in ED as well as testosterone levels and consequently CVD. Kirby M. The circle of lifestyle and erectile dysfunction. Sex Med Rev 2015;3:169-182.

Relationship between lifestyle and health factors and severe lower urinary tract symptoms (LUTS) in 106,435 middle-aged and older Australian men: population-based study

Background

Despite growing interest in prevention of lower urinary tract symptoms (LUTS) through better understanding of modifiable risk factors, large-scale population-based evidence is limited.

Objective

To describe risk factors associated with severe LUTS in the 45 and Up Study, a large cohort study.

Design, Setting, and Participants

A cross-sectional analysis of questionnaire data from 106,435 men aged ≥45 years, living in New South Wales, Australia.

Outcome Measures and Statistical Analysis

LUTS were measured by a modified version of the International Prostate Symptom Score (m-IPSS). The strength of association between severe LUTS and socio-demographic, lifestyle and health-related factors was estimated, using logistic regression to calculate odds ratios, adjusted for a range of confounding factors.

Results

Overall, 18.3% reported moderate, and 3.6% severe, LUTS. Severe LUTS were more common among men reporting previous prostate cancer (7.6%), total prostatectomy (4.9%) or having part of the prostate removed (8.2%). After excluding men with prostate cancer or prostate surgery, the prevalence of moderate-severe LUTS in the cohort (n = 95,089) ranged from 10.6% to 35.4% for ages 45–49 to ≥80; the age-related increase was steeper for storage than voiding symptoms. The adjusted odds of severe LUTS decreased with increasing education (tertiary qualification versus no school certificate, odds ratio (OR = 0.78 (0.68–0.89))) and increasing physical activity (high versus low, OR = 0.83 (0.76–0.91)). Odds were elevated among current smokers versus never-smokers (OR = 1.64 (1.43–1.88)), obese versus healthy-weight men (OR = 1.27 (1.14–1.41)) and for comorbid conditions (e.g., heart disease versus no heart disease, OR = 1.36 (1.24–1.49)), and particularly for severe versus no physical functional limitation (OR = 5.17 (4.51–5.93)).

Conclusions

LUTS was associated with a number of factors, including modifiable risk factors, suggesting potential targets for prevention.

Experiences and treatment patterns of hypogonadal men in a U.S. health system

OBJECTIVE

To examine self-reported experiences with hypogonadism (HG) and patterns of testosterone replacement therapy (TRT) in men seeking care in a U.S. healthcare system.

METHODS

Men ≥ 18 years old with HG were identified from the 2008-2010 Reliant electronic medical records database. Surveys, including validated instruments for measuring symptoms of HG, were collected and evaluated for demographic and behavioural data.

RESULTS

Surveys were mailed to 133 men with HG in 2012. Of the 107 surveys returned, 95 were included in the final analysis. Most respondents were Caucasian (90.5%). Men reported developing symptoms of HG, as well as being diagnosed, at a median age of 50 years. The most common symptoms reported as reasons for seeking treatment were erectile dysfunction (66.3%), fatigue (59.0%) and decreased sex drive (57.9%). These continued to be the most bothersome symptoms at the time of the survey regardless of whether the patient received treatment, although men who were currently taking TRT reported less severe symptoms. Approximately 88% of men reported taking TRT at some point, with 61.9% on therapy at the time of the survey.

CONCLUSIONS

This study examined men's experiences with HG, including symptoms, quality of life, and treatments. Some symptoms continued despite treatment, and therapy was discontinued at a high rate, which men generally attributed to cost and perceptions of efficacy. In light of this lack of adherence, patients may benefit from appropriate expectation setting regarding reasonable timelines for symptom improvement, the strengths and challenges of various TRT formulations, the importance of adherence and the benefits and risks of TRT.

Healthy aging in a cross-sectional study of Australian men: what has sex got to do with it?

AIM

To identify lifestyle factors associated with healthy aging in middle-aged and older Australian men.

METHODS

A cross-sectional, population-based, computer-assisted telephone interview study explored self-reported health outcomes, and associated determinants for general and reproductive health (the Men in Australia Telephone Survey) in men aged 40 years and older (n = 5990). "Good health" was defined by self-reported health (excellent/very good) combined with absence of self-reported high blood pressure, heart disease, stroke, diabetes and depression symptoms. Categories of sexual activity frequency in the previous four weeks ranged from zero to 12+ times.

RESULTS

"Good health" declined with increasing age with 17% of men over 70 years reporting "good health". In multivariable logistic regression models, significant inverse associations were found between modifiable lifestyle factors - both underweight and overweight/obesity, physical inactivity, smoking and high alcohol consumption - and "good health". Low-risk alcohol intake and living with a partner were positively associated with "good health". Sexual activity was also positively associated with "good health" (p < 0.001) with elevated odds ratios (ORs) for each category of frequency of sexual activity (1-4, 5-8, 9-12 or 12+ times in the past 4 weeks) relative to zero frequency (ORs 1.68 to 2.16).

CONCLUSION

This study suggests that sexual activity is an important correlate of retaining good health in middle- and older-aged men, independent of other behavioral determinants.

PDE5-Is for the Treatment of Concomitant ED and LUTS/BPH

Epidemiologic data in adult men exhibit a strong relationship between erectile dysfunction (ED) and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), indicating that men affected by ED should also be investigated for LUTS/BPH and those presenting with storage or voiding LUTS should be investigated for co-morbid ED. Common pathophysiolgical mechanisms underlying both LUTS/BPH and ED, including alteration of NO/cGMP or RhoA/Rho-kinase signaling and/or vascular or neurogenic dysfunction, are potential targets for proposed phosphodiesterase type 5 inhibitors (PDE5-Is). Several randomized controlled trials and only a few reviews including all commercially available PDE5-Is demonstrated the safety and efficacy of these drugs in the improvement of erectile function and urinary symptoms, in patients affected either by ED, LUTS, or both conditions.

Erectile dysfunction

Erectile dysfunction is a common clinical entity that affects mainly men older than 40 years. In addition to the classical causes of erectile dysfunction, such as diabetes mellitus and hypertension, several common lifestyle factors, such as obesity, limited or an absence of physical exercise, and lower urinary tract symptoms, have been linked to the development of erectile dysfunction. Substantial steps have been taken in the study of the association between erectile dysfunction and cardiovascular disease. Erectile dysfunction is a strong predictor for coronary artery disease, and cardiovascular assessment of a non-cardiac patient presenting with erectile dysfunction is now recommended. Substantial advances have occurred in the understanding of the pathophysiology of erectile dysfunction that ultimately led to the development of successful oral therapies, namely the phosphodiesterase type 5 inhibitors. However, oral phosphodiesterase type 5 inhibitors have limitations, and present research is thus investigating cutting-edge therapeutic strategies including gene and cell-based technologies with the aim of discovering a cure for erectile dysfunction.

Body mass index, sexual difficulties and sexual satisfaction among people in regular heterosexual relationships: a population-based study

BACKGROUND/AIMS

The aims of this study were to clarify the relationship between body mass index (BMI) and sexual difficulties and to investigate if BMI influenced sexual satisfaction, over and above the effects of sexual difficulties.

METHODS

Cross-sectional analyses of a nationally representative computer-assisted telephone interview. Eight thousand, six hundred and fifty-six respondents were recruited by random digit dialling in 2004-2005. Only those in a sexually active, heterosexual relationship were included in the current analyses.

RESULTS

After adjustments for demographic factors, both overweight and obese male and female participants were more likely to report worrying during sex about whether their body was unattractive. Among women, associations were also found between higher BMI and lack of interest in sex. No other significant associations between BMI and sexual difficulties were evident. There was an association between BMI and extreme physical pleasure for women but not men over and above the effects of sexual difficulties, with obese women being more likely than normal weight women to report extreme physical pleasure. No associations were found for either men or women between BMI and whether or not they reported extreme emotional or sexual satisfaction with their relationship.

CONCLUSIONS

With the exception of body image difficulties, there is little association between BMI and self-reported sexual difficulties. Furthermore, extreme sexual and emotional satisfaction appeared to be associated with the presence or absence of sexual difficulties and not overly influenced by BMI. Overall, clinicians and patients should be aware that being overweight is not necessarily detrimental to sexual functioning.

The Global Online Sexuality Survey (GOSS): the United States of America in 2011. Chapter I: erectile dysfunction among English-speakers

INTRODUCTION

The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, based on validated questionnaires and applying age adjustment to the World Standard Population (WSP) by the World Health Organization. In 2010, the first report of GOSS came from the Middle East, describing an erectile dysfunction (ED) prevalence rate of 47%.

AIM

This report studies the prevalence rate of ED in the United States as of 2011-2012 and evaluates risk factors for ED.

MAIN OUTCOME MEASURES

Prevalence of ED.

METHODS

GOSS was randomly deployed to English-speaking male web surfers in the United States via paid advertising on Facebook, comprising 146 questions including the abbreviated 5-item International Index of Erectile Function.

RESULTS

Two thousand twenty-two males participated; with a mean age was 52.38 years ± 14.5. Prevalence of ED was 37.7%, adjusted to 33.7% according to WSP, comparable across ethnic groups. The following risk factors were associated with higher risk for ED: diabetes mellitus, hypertension with and without antihypertensive treatment, coronary heart disease, obesity (defined by body mass index), difficult micturition, subjectively reported depression, interpersonal distress, subjectively reported impotence, in addition to novel factors such as subjectively reported premature ejaculation (PE) and concerns over genital size (not a smaller penis per se), low libido, and irregular coitus. Frequency of smoking and alcohol were not associated with higher prevalence of ED, although duration of smoking was.

CONCLUSION

Adjusted to WSP, prevalence rate of ED in the United States of America is 33.7% in the year 2011, in contrast to the adjusted prevalence in the Middle East (47%). Most of the classical risk factors for ED play the same role in the United States and the World, including diabetes, hypertension, and aging. Concerns over genital size and PE are emerging risk factors for ED.

Sexual dysfunction in males with systolic heart failure and associated factors

BACKGROUND

Erectile dysfunction (ED) is the inability to achieve or maintain the adequate erection for intercourse. Heart failure is a major risk factor for erectile dysfunction. The aim of this study was to investigate the prevalence and factors associated with erectile dysfunction in systolic heart failure.

METHODS

In a cross-sectional study 100 male patients with systolic heart failure were selected using convenience sampling method. IIEF-5 questionnaire (the International Index of Erectile Function, 5-item version), MLHFQ (Minnesota Living with Heart Failure Questionnaire) and CES-D (Centre for Epidemiologic Studies Depression Scale) were used to obtain data.

RESULTS

Mean score of erectile dysfunction was 14.02 ± 6.26 and 80% of heart failure patient had erectile dysfunction. Erectile dysfunction was significantly associated with age (P < 0.001), education (P = 0.019), occupation (P = 0.002), hemoglobin level (P = 0.003), left ventricular ejection fraction (P = 0.030), cholesterol level (P = 0.001), renal dysfunction (P = 0.009), use of digoxin (P = 0.014), angiotensin converting enzyme inhibitors (P < 0.001), beta blocker (P = 0.001), diuretics (P = 0.035), depression (P < 0.001) and quality of life (P < 0.001).

CONCLUSION

Erectile dysfunction (ED) was common in systolic heart failure and was associated with age, medical conditions, co morbidities, drugs for treatment and psychological disorders. In heart failure patients erectile dysfunction had negative impact on quality of life.

Are commonly used psychoactive medications associated with lower urinary tract symptoms?

PURPOSE

Lower urinary tract symptoms (LUTS) such as urinary frequency and urgency are bothersome and associated with reduced quality of life. Atypical antipsychotics (AAPs) have been implicated in increasing the risk of urinary incontinence. In a large community-based sample of men and women, we examined the associations of AAP and selective serotonin reuptake inhibitor (SSRIs) use with LUTS.

METHODS

Data were collected (2002-2005) from a generalizable sample of Boston, MA, USA, residents aged 30-79 (N = 5503). LUTS were assessed using the American Urologic Association Symptom Index (AUA-SI). The prevalence of clinically-significant LUTS was estimated using a cutoff AUA-SI score of 8+ to indicate moderate-to-severe symptoms. Confounder-adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated from multivariate logistic regression to estimate the associations for psychoactive drugs used in the previous month (SSRIs, AAPs, both) and LUTS.

RESULTS

Among women, AAP users had a higher prevalence of LUTS (46.2%) compared with SSRI users (23.5%) and those with depressive symptoms not using SSRIs or AAPs (26.3%). Corresponding prevalence estimates among men were 32.7%, 29.8%, and 33.3%. In multivariate models, AAP use was significantly associated with LUTS among women when used either with (OR = 2.72, 95% CI:1.45-5.10) or without (OR = 3.05, 95% CI:1.30-7.16) SSRIs, but SSRI use without AAP use was not associated with LUTS compared with nonusers without depressive symptoms. No associations were observed among men.

CONCLUSIONS

In our study, AAPs but not SSRIs were associated with increased prevalence of LUTS among women only. Further prospective research is needed to determine time sequence and cause and effect.

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.