Erectile [Dys]Function

[Michael Scally MD]

Self-Regulation in the Pharmaceutical Industry: The Exposure of Children and Adolescents to Erectile Dysfunction Commercials

Context: Spending on direct-to-consumer advertising (DTCA) for prescription pharmaceuticals has risen to record levels, five times as much as in 1996 in inflation-adjusted dollars. Major health care provider organizations have called for additional regulation of DTCA.

These organizations argue that the negative impact of such advertising outweighs the informational value claimed by the pharmaceutical industry. The industry maintains that further restrictions on DTCA are not warranted because it is successfully self-regulating via "guiding principles" for DTCA as certified by firm executives.

Methods: The authors measured recent industry spending on DTCA and used regression models of Nielsen Monitor-Plus data to assess pharmaceutical firm self-regulation after the public disclosure of noncompliance with industry self-regulatory principles, specifically regarding the exposure of children and adolescents to broadcast advertisements for erectile dysfunction drugs.

Findings: Public disclosure of noncompliance with self-regulatory DTCA standards did not bring advertising into compliance. Results demonstrate that firms failed to meet the industry standard during every quarter of the six-year period of this study.

Conclusions: Results support previous research findings that pharmaceutical self-regulation is a deceptive blocking strategy rather than a means for the industry to police itself. Policy recommendations include broadcast restrictions on adult content and deincentivizing DTCA via tax reform.

Arnold DG, Oakley JL. Self-Regulation in the Pharmaceutical Industry: The Exposure of Children and Adolescents to Erectile Dysfunction Commercials. J Health Polit Policy Law. 2019;44(5):765–787. Self-Regulation in the Pharmaceutical Industry: The Exposure of Children and Adolescents to Erectile Dysfunction Commercials | Journal of Health Politics, Policy and Law | Duke University Press

 

[Atillah67]

Has anyone heard of a penile implant being successful on a man who has previously been injected with silicone? I'm wondering if its even really possible.

Current Diagnosis and Management of Erectile Dysfunction

Summary

· Erectile dysfunction (ED) is a common male sexual dysfunction associated with a reduced quality of life for patients and their partners.

· ED is associated with increasing age, depression, obesity, lack of exercise, diabetes mellitus, hypertension, dyslipidaemia, cardiovascular disease and lower urinary tract symptoms related to benign prostatic hyperplasia.

· The evaluation of men with ED requires a full medical and personally and culturally sensitive sexual history, a focused clinical examination, fasting glucose levels, a fasting lipid profile and, in select cases, a total testosterone level and a prostate‐specific antigen test.

· Treatment of ED requires lifestyle modification, reduction of comorbid vascular risk factors, and treatment of organic or psychosexual dysfunction with either pharmacotherapy alone or in combination with psychosexual therapy.

· Between 60% and 65% of men with ED, including those with hypertension, diabetes mellitus, spinal cord injury and other comorbid medical conditions, can successfully complete intercourse in response to the phosphodiesterase type 5 inhibitors (PDE5i) sildenafil, tadalafil, vardenafil and avanafil.

· Patient‐administered intracorporal injection therapy using vasodilator drugs such as alprostadil is an effective treatment and is useful in men who fail to respond to oral pharmacological agents.

· Surgical treatment of ED with multicomponent inflatable penile implants is associated with high satisfaction rates.

· Penile arterial revascularisation and venous ligation surgery are associated with relatively poor outcome results in men with penile atherosclerotic disease or corporal veno‐occlusive dysfunction.

McMahon CG. Current diagnosis and management of erectile dysfunction. The Medical journal of Australia 2019. Error - Cookies Turned Off

 

[Michael Scally MD]

A Rare Cause of Erectile Dysfunction: Left Ventricular Diastolic Dysfunction

Background: The aim of this study was to investigate the association between left ventricular diastolic dysfunction (LVDD) and erectile dysfunction (ED) without overt cardiovascular disease.

Methods: A total of 80 patients with LVDD and without a history of coronary artery disease were compared with 80 age- and gender-matched healthy controls. The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade ED. LVDD and its relation with ED severity were assessed.

Results: The mean age, body mass index, total testosterone, low- and high-density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the LVDD and control groups (p > 0.05). There was a negative correlation between the stage of LVDD and IIEF-5 score (r = -0.635, p < 0.05). Additionally, the left atrial volume index, peak TR velocity and E/e' ratio were independent risk factors for lowering the IIEF-5 score.

Conclusions: This study indicates that LVDD is significantly associated with ED. There were significant associations between the increased severity of ED and the presence of LVDD in middle-aged men.

Ceyhun G, Erbay G. A rare cause of erectile dysfunction: left ventricular diastolic dysfunction [published online ahead of print, 2020 Mar 11]. Minerva Cardioangiol. 2020;10.23736/S0026-4725.20.05149-X. doi:10.23736/S0026-4725.20.05149-X A rare cause of erectile dysfunction: left ventricular diastolic dysfunction - Minerva Cardioangiologica 2020 Mar 11 - Minerva Medica - Journals

 

[chileandawg]

A Rare Cause of Erectile Dysfunction: Left Ventricular Diastolic Dysfunction

Background: The aim of this study was to investigate the association between left ventricular diastolic dysfunction (LVDD) and erectile dysfunction (ED) without overt cardiovascular disease.

Methods: A total of 80 patients with LVDD and without a history of coronary artery disease were compared with 80 age- and gender-matched healthy controls. The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade ED. LVDD and its relation with ED severity were assessed.

Results: The mean age, body mass index, total testosterone, low- and high-density lipoprotein cholesterol, and triglyceride levels did not significantly differ between the LVDD and control groups (p > 0.05). There was a negative correlation between the stage of LVDD and IIEF-5 score (r = -0.635, p < 0.05). Additionally, the left atrial volume index, peak TR velocity and E/e' ratio were independent risk factors for lowering the IIEF-5 score.

Conclusions: This study indicates that LVDD is significantly associated with ED. There were significant associations between the increased severity of ED and the presence of LVDD in middle-aged men.

Ceyhun G, Erbay G. A rare cause of erectile dysfunction: left ventricular diastolic dysfunction [published online ahead of print, 2020 Mar 11]. Minerva Cardioangiol. 2020;10.23736/S0026-4725.20.05149-X. doi:10.23736/S0026-4725.20.05149-X A rare cause of erectile dysfunction: left ventricular diastolic dysfunction - Minerva Cardioangiologica 2020 Mar 11 - Minerva Medica - Journals

Oh man, that sounds like the end of the world, but yeah I have to be very careful about my family cardiovascular historial.

 

[Michael Scally MD]

Gene Polymorphisms Affecting Erectile Dysfunction

Introduction: Erectile dysfunction (ED) is usually developed from psychological, neurological, hormonal, and vascular pathologies or a combination of these factors. However, the possible genetic polymorphisms that might underlie this disorder were not thoroughly investigated.

Objectives: This review article aimed to assess the possible involvement of gene polymorphisms in men with ED.

Methods: A systematic review was conducted until January 2020 based on a search of all relevant articles in many electronic sites such as PubMed, Medline Medical Subject Headings, Science Direct, Scopus, Cochrane Library, EMBASE, CINAHL, and Egyptian Knowledge Bank databases with no language restriction. Keywords used to assess the outcome and estimates for relevant associations were sexual health, genes, erectile dysfunction, polymorphisms, and cavernous tissues.

Results: Many genetic studies were carried out to inspect the contribution of different encoded genotypes and ED. Overall, 50 studies were reviewed and were classified as per the type of gene polymorphisms. These studies have investigated 10,174 men with ED compared with 6,891 healthy men as controls. 35 studies were case-controlled, 13 cross-sectional cohort studies, one retrospective study, and one genome-wide association study.

So far, the most relevant gene polymorphisms linked with men with ED included endothelial nitric oxide synthase (eNOS), angiotensin-converting enzyme (ACE), androgen receptor (AR) CAG repeat, G-protein β3 (GNB3) subunit, methylenetetrahydrofolate reductase (MTHFR), vascular endothelial growth factor (VEGF), TGFB1, proprotein convertase subtilisin/kexin type 9 (PCSK9), ARG1, DRD2, DRD4, DDAH, and HNF4A genes. Both PROGINS and IGFBP-3 polymorphisms were investigated in only one study each but with irrelevant significance.

Conclusions: Although several genetic studies exposed the association between different genotypes and men with ED with varied outcomes, such a relationship should not be overlooked. Therefore, more studies should be encouraged to elucidate the exact role, if any, for such association.

Mostafa T, Taymour M. Gene Polymorphisms Affecting Erectile Dysfunction [published online ahead of print, 2020 Mar 10]. Sex Med Rev. 2020;S2050-0521(20)30005-6. doi:10.1016/j.sxmr.2020.02.001 Gene Polymorphisms Affecting Erectile Dysfunction - ScienceDirect

 

[Atillah67]

Oh man, that sounds like the end of the world, but yeah I have to be very careful about my family cardiovascular historial.

In many ways it is. Those with it who have left untreated basically have to keep surviving in hopes of eventually getting it fixed to find a partner.

 

[Michael Scally MD]

Efficacy and Safety of Common Ingredients in Aphrodisiacs Used for Erectile Dysfunction

Introduction - Erectile dysfunction (ED) is the inability to attain or sustain an erection for sexual intercourse. Affected men endorse difficulties with intimacy and feelings of guilt and shame. Although medical treatments are available, patients are reluctant to discuss ED with physicians and often use dietary supplements to attempt to treat their ED. As such, there is a need to better understand the effects of ingredients used in nutraceuticals for ED treatment.

Objectives - To summarize the literature on the efficacy and safety of the most common ingredients used in ED supplements.

Methods - 10 of the most common ingredients in ED supplements were reviewed using PubMed-indexed literature to assess their efficacy and safety in treating ED. Key findings were summarized to include historical use, active ingredients, prior animal studies, human studies, and toxicity.

Results - Nutraceuticals used in ED treatment include a variety of ingredients. Although L-arginine is a safe supplement with clinical data supporting improved erectile function, limited data exist on the efficacy of other ingredients in the treatment of ED.

Conclusion - Despite the growing use of supplements for treatment of sexual dysfunction, ED supplements remain poorly studied, with limited data demonstrating efficacy of individual ingredients. Further study is required to definitively determine the efficacy of nutraceuticals in ED treatment.

Srivatsav A, Balasubramanian A, Pathak UI, et al. Efficacy and Safety of Common Ingredients in Aphrodisiacs Used for Erectile Dysfunction: A Review. J Sex Med 2020. https://www.smr.jsexmed.org/article/S2050-0521(20)30002-0/abstract

 

[Michael Scally MD]

Do testosterone supplements enhance response to phosphodiesterase 5 inhibitors in men with erectile dysfunction and hypogonadism?

Background: Combining testosterone and phosphodiesterase 5 inhibitors (PDE5-Is) has become increasingly common in the treatment of men with erectile dysfunction (ED) and low testosterone levels, but combination therapy involving PDE5-Is and testosterone is highly debated, with strong reasons for and against argued by the various opinion leaders.

PDE5-Is can be given prior to, alongside or after the commencement of any testosterone replacement therapy. Meanwhile, combination of PDE5-Is and testosterone is reported to better increase testosterone levels and thus improve International Index of Erectile Function (IIEF) score in hypogonadal men.

The objective of this meta-analysis was to assess whether testosterone therapy (TTh) can possibly enhance the reaction to PDE5-Is in men with ED and hypogonadism.

Methods: Relevant studies and available data were extensively collected form Medline, Embase, and Cochrane Library databases until June 2019. We calculated standard mean differences (SMDs) with their 95% confidence intervals (CIs) for IIEF including IIEF-5 and IIEF-EFD. Trial sequential analysis (TSA) was performed to explore whether the sample size of the accumulated evidence is sufficient.

Results: There were 8 studies including 913 patients. The pooled SMD of erectile function (EF) component change was 0.663 [(0.299 to 1.027); P<0.0001], which concluded that combination therapy (TTh plus PDE5-Is) is superior to PDE5-Is monotherapy group.

We also conducted a subgroup analysis according to trial follow-up, baseline serum total testosterone, baseline EF score and PDE5-Is type, which may explain for the underlying source of heterogeneity in part. The frequency of adverse events and change in PSA levels did not differ between the 2 groups.

None of the patients experienced an increase in the prostate specific antigen (PSA) level above 4 ng/mL. Hematocrit increased significantly more in the testosterone group than in the placebo group but not greater than 0.54.

Conclusions: In summary, the present results confirm that combination therapy is effective and safe. TTh can enhance the reaction to PDE5-Is in men with ED and hypogonadism, but this effect also depends on the specific diagnosis and initial response to PDE5-Is. Most patients with adverse events during treatment are mild, and have a stable overall safety of combination therapy.

Zhu J, Zhang W, Ou N, et al. Do testosterone supplements enhance response to phosphodiesterase 5 inhibitors in men with erectile dysfunction and hypogonadism: a systematic review and meta-analysis. Translational andrology and urology 2020;9:591-600. Do testosterone supplements enhance response to phosphodiesterase 5 inhibitors in men with erectile dysfunction and hypogonadism: a systematic review and meta-analysis - Zhu - Translational Andrology and Urology

 

[Michael Scally MD]

Is it all in my head? Self-reported psychogenic erectile dysfunction and depression are common among young men seeking advice on social media.

Objectives: To characterize themes of discussion and specific concerns expressed by users of an internet erectile dysfunction (ED) community using a mixed-methodology approach involving quantitative natural language processing (NLP) and qualitative annotation of content.

Methods: We extracted posts and responses from the Reddit community r/ErectileDysfunction (3100 members) during 6/2018-5/2019. We applied an NLP technique called the meaning extraction method with principal component analysis (MEM/PCA) to computationally identify themes of discussion. We manually annotated a subset (30%) of posts based on NLP-derived themes to evaluate specific content.

Results: We analyzed 329 posts and 1702 responses. MEM/PCA identified key themes: hypogonadism symptoms, masturbation/sex, evaluation/treatment, alternative therapies, and partner factors (posts); and performance anxiety, hypogonadism evaluation, pornography, and pharmacotherapy (responses). Subset annotation of 100 posts revealed a median author age of 24 years (IQR 20-31). 48% of discussants believed their ED was psychogenic, 38% reported depressive symptoms, and 2% mentioned self-harm/suicidality either attributed to or associated with their ED. 28% of discussants reported seeing a health care professional for ED, and 20% attempted abstinence from pornography/masturbation as a self-prescribed intervention.

Conclusions: Social media platforms like Reddit empower young men to discuss ED concerns. Fewer than one-third reported seeing a doctor for ED, suggesting that men turn to peers on the internet first, despite risk of misinformation. A majority attributed symptoms to psychological etiologies and excess pornography/masturbation. Depression, self-harm, and suicide emerged as potent concerns. These data underscore the importance of engaging proactively with young men, both in the consultation room and online.

Jiang T, Osadchiy V, Mills JN, Eleswarapu SV. Is it all in my head? Self-reported psychogenic erectile dysfunction and depression are common among young men seeking advice on social media [published online ahead of print, 2020 May 10]. Urology. 2020;S0090-4295(20)30525-2. doi:10.1016/j.urology.2020.04.100 https://www.goldjournal.net/article/S0090-4295(20)30525-2/pdf

 

[Michael Scally MD]

Risk Factors for Hypogonadism in Young Men with Erectile Dysfunction

Background: The objective of this study is to evaluate the hormone profile of young men with the chief complaint of erectile dysfunction (ED) and determine the comorbidities in this population.

Methods: A retrospective chart review of men aged 18 to 40 years who presented with ED and had a hormone evaluation but without prior medication for hormone manipulation from 2002 to 2016 was performed at a tertiary care institution. Data were obtained on demographics, comorbidities, medications, and hormonal evaluations.

Results: A total of 2292 men with ED were identified and 2130 of them received testosterone level evaluation. The most common comorbidities that men were actively being treated for were depression (22.3%), anxiety (16.1%), hypertension (15.6%), diabetes (7.2%), cancer (6.2%), and cardiovascular disease (3.3%). The average total testosterone level was 368 ± 160 ng/dL; 10.7% of men had hypogonadism.

Multivariate analysis demonstrated age, body mass index (BMI), depression, and cancer predicted a hypogonadal status. Patients with BMI > 28.2 kg/m, age > 34 years, cancer diagnosis, or depression were 3.350-fold, 1.447-fold, 2.317-fold, or 1.420-fold more likely to be diagnosed hypogonadal than nonoverweight, age ≤ 34 years, noncancer, or nondepressive patients.

Conclusion: The majority of men under the age of 40 with ED exhibit a normal hormonal milieu. Young ED men with BMI > 28.2 kg/m, age >34 years, cancer diagnosis, or depression are at risk for hypogonadism.

Huang IS, Mazur DJ, Kahn BE, et al. Risk factors for hypogonadism in young men with erectile dysfunction. J Chin Med Assoc. 2019;82(6):477‐481. doi:10.1097/JCMA.0000000000000099 Risk factors for hypogonadism in young men with erectile... : Journal of the Chinese Medical Association

 

[Michael Scally MD]

Direct-To-Consumer Internet Prescription Platforms Overlook Crucial Pathology Found During Traditional Office Evaluation of Young Men with Erectile Dysfunction

Objective: To determine comorbidities in young men with erectile dysfunction (ED) who are increasingly targeted by direct-to-consumer (DTC) internet platforms that sell phosphodiesterase-5 (PDE-5) inhibitors without comprehensive clinical evaluation; and, further, to characterize the portrayal of DTC platforms by popular news media.

Methods: We retrospectively reviewed all men age ≤40 evaluated for ED at an andrology clinic during 1/2016-3/2019 to obtain demographics, exam and lab findings, and treatments. Five news sources were analyzed during the study period to characterize whether articles about DTC platforms were positive, critical, or balanced/neutral.

Results: We identified 388 patients, with age 29.5 ± 5.0 years, 15% rate of obesity, 20% pre-diabetes or diabetes, 54% dyslipidemia, and 20% hypogonadism. Serum lab findings associated with subfertility were found in 11%. Semen analysis was conducted in 64 men, of whom 40% were abnormal. Varicoceles were found in 35%. PDE-5 inhibitor was prescribed to 328 men (88%). Off-label empiric therapies included clomiphene (32.9%) or aromatase inhibitor (12.1%). Testosterone replacement was initiated in 9.7%. Analysis of news coverage revealed 18 articles, of which 61% portrayed DTC platforms exclusively in a positive light.

Conclusions: Office consultation identified young men with significant comorbidities that would be missed by DTC platforms, which employ only questionnaires for health screening. DTC platforms present themselves as medical authorities without following AUA Guidelines, yet garner mostly positive press coverage.

Patients engaging these platforms may falsely believe they are receiving adequate medical assessment. Urologists may do well to incorporate telemedicine to enfranchise young men with evidence-based evaluation.

Shahinyan RH, Amighi A, Carey AN, et al. Direct-to-consumer internet prescription platforms overlook crucial pathology found during traditional office evaluation of young men with erectile dysfunction [published online ahead of print, 2020 Jun 11]. Urology. 2020;S0090-4295(20)30667-1. doi:10.1016/j.urology.2020.03.067 https://www.goldjournal.net/article/S0090-4295(20)30667-1/pdf

 

[Michael Scally MD]

An Evaluation of a Clinical Care Pathway for the Management of Men With Nonorganic Erectile Dysfunction

Introduction: There exists little literature on the outcomes of the medical management of men with erectile dysfunction (ED) with no overt organic etiology.

Aim: This study was conducted to assess the outcomes of men with nonorganic ED treated medically.

Methods: All patients had normal hormone profiles and vascular assessment. All were given a trial of a phosphodiesterase type 5 inhibitor (PDE5i). If no improvement was experienced, intracavernosal injection (ICI) therapy was administered. All patients were encouraged to seek a consultation with a mental health professional.

Main outcome measure: Patient demographics, medical comorbidities, hormone and hemodynamics assessments, and change in International Index of Erectile Function scores of patients were recorded.

Results: 116 men with a mean age or 38 ± 19 (range 16-57) years were studied. 21% had mild ED, 47% had moderate ED, and 32% had severe ED. 21% had seen a psychiatrist. 81% of patients responded to PDE5i with a penetration hardness erection on follow-up (mean duration of 7 ± 3 months postcommencement of PDE5i).

However, only 68% of these were capable of a consistently good response. The mean Erectile Function domain score on PDE5i for the entire group improved from 18 ± 11 to 22 ± 6 (P = .01), and for PDE5i responders it was 27 ± 4 (P < .001). 28% of men (22 PDE5i failures and 10 with a mixed response to PDE5i) attempted ICI, all obtaining consistently functional erections.

At a mean time point of 11 ± 5 months, 83% of those responding to PDE5i had ceased using PDE5i due to a lack of need. 11% of those using ICI continued to use them 6 months after starting ICI; the remainder had been transitioned back to PDE5i. Of the 29 patients in the latter subgroup, 66% were no longer using PDE5i consistently due to a lack of need.

Clinical implications: Not all men with nonorganic ED respond to PDE5i initially and many of those who respond do so only intermittently; such patients are potentially curable, using erectogenic pharmacotherapy for erectile confidence restoration, most men are capable of being weaned from drug therapy.

Strengths & limitations: The strengths of the study are the large number of patients and the use of serial validated instruments to assess erectile function outcomes. As a weakness, despite normal hormone and vascular assessments, the diagnosis of nonorganic ED is still a presumptive one.

Conclusion: Medical management of nonorganic ED utilizing the process of care model results in cure in a large proportion of such patients. The transient use of ICI in some patients permits successful PDE5i rechallenge.

Jenkins LC, Hall M, Deveci S, et al. An Evaluation of a Clinical Care Pathway for the Management of Men With Nonorganic Erectile Dysfunction. J Sex Med. 2019;16(10):1541-1546. doi:10.1016/j.jsxm.2019.07.013 https://www.jsm.jsexmed.org/article/S1743-6095(19)31317-7/fulltext

 

[Michael Scally MD]

 

[Michael Scally MD]

The Role of Hormones in Male Sexual Function

Purpose of Review - Male sexual dysfunction has many different causes and is often multifactorial in nature. We aim to review the effects that testosterone (T), estrogen, thyroid hormone, prolactin (PRL), and cortisol have on male sexual function.

Recent Findings - T deficiency can cause decreased libido and diminished erectile function. Estrogen is necessary for sexual drive but is postulated to inhibit erectile function when elevated. Hyperthyroidism is associated with premature ejaculation (PE), hypothyroidism is associated with delayed ejaculation (DE), and both are associated with erectile dysfunction (ED). Hyperprolactinemia is associated with ED and can cause fertility issues. The role of corticosteroids is largely unknown.

Summary - While hormonal disorders can largely influence male sexual health, resolution of sexual dysfunction is achieved in most cases by normalization of hormone levels.

Dick, B., Koller, C., Herzog, B. et al. The Role of Hormones in Male Sexual Function. Curr Sex Health Rep (2020). https://doi.org/10.1007/s11930-020-00271-7

 

[Michael Scally MD]

Erectile Dysfunction: Could It Be Genetic?

Outside of lifestyle modifications of known ED risk factors, current therapies cannot reverse the underlying cause of ED or alter disease progression. As with many other conditions, there is a growing interest in the genetic underpinnings of ED in an effort to one day develop novel therapies designed with these specific goals. An early twin study from the Vietnam Era Twin Registry was 1 of the first to support the heritability of ED among 890 monozygotic and 619 dizygotic twin pairs. Difficulties with erectile function were simply assessed using 2 questions: difficulty with initially obtaining and/or maintaining a penile erection. The adjusted heritability estimate for ED was 29% for the ability to obtain and 36% for the ability to maintain an erection.

In the following decade, an abundance of candidate gene studies were published that further supported a genetic component of ED. Candidate gene studies assess genetic variation (polymorphisms) within prespecified genes of interest and the association with certain disease phenotypes. These genes are selected by the investigator based on prior knowledge of the gene's biological function. However, these studies have several limitations.

More recently, genome-wide association studies (GWAS) have emerged as an alternative method to better understand the genetics of ED. GWAS assess an individual's whole genome for millions of genetic variants to identify unique genotype-phenotype associations. GWAS can better address the polygenic etiology of most complex conditions such as ED. Sharing of large whole genome data sets, decreased sequencing costs, and more efficient phenotyping through links to existing electronic medical records make GWAS a viable option for new discoveries. We review the current understanding of the genetics of ED and future investigations.

Patel DP, Hotaling JM. Erectile Dysfunction: Could It Be Genetic? The Journal of Sexual Medicine 2020;17:1239-41. http://www.sciencedirect.com/science/article/pii/S1743609520301831

 

[Michael Scally MD]

[OA] Different Levels of Estradiol are Correlated with Sexual Dysfunction

Ejaculatory dysfunction, including premature ejaculation (PE) and delayed ejaculation (DE), as well as erectile dysfunction (ED), constitute the majority of male sexual dysfunction. Despite a fair amount of data on the role of hormones and erection and ejaculation, it is inconclusive due to controversy in the current literature.

To explore the correlation of male sexual dysfunction with hormonal profile, 1,076 men between the ages of 19–60 years (mean: 32.12 years) were included in this retrospective case–control study; 507 were categorized as ED, PE and DE groups. Five hundred and sixty-nine men without sexual dysfunction were enrolled in the control group. The background characteristics and clinical features of the four groups were collected and analyzed.

The estradiol value was significantly elevated in the ED group than the control group (109.44 ± 47.14 pmol/L vs. 91.88 ± 27.68 pmol/L; P < 0.001). Conversely, the DE group had significantly lower level of estradiol than control did (70.76 ± 27.20 pmol/L vs. 91.88 ± 27.68 pmol/L; P < 0.001). The PE group had similar level of estradiol (91.73 ± 31.57 pmol/L vs. 91.88 ± 27.68 pmol/L; P = 0.960) but significantly higher level of testosterone (17.23 ± 5.72 nmol/L vs. 15.31 ± 4.31 nmol/L; P < 0.001) compared with the control group.

In conclusion, elevated serum testosterone concentration was an independent risk factor for PE. Besides, there was a progressively increasing graded-distribution of estradiol values from DE to PE and ED groups.

Chen, T., Wu, F., Wang, X. et al. Different levels of estradiol are correlated with sexual dysfunction in adult men. Sci Rep 10, 12660 (2020). https://doi.org/10.1038/s41598-020-69712-6

 

[Millard]

The estradiol value was significantly elevated in the ED group than the control group (109.44 ± 47.14 pmol/L vs. 91.88 ± 27.68 pmol/L; P < 0.001). Conversely, the DE group had significantly lower level of estradiol than control did (70.76 ± 27.20 pmol/L vs. 91.88 ± 27.68 pmol/L; P < 0.001). The PE group had similar level of estradiol (91.73 ± 31.57 pmol/L vs. 91.88 ± 27.68 pmol/L; P = 0.960) but significantly higher level of testosterone (17.23 ± 5.72 nmol/L vs. 15.31 ± 4.31 nmol/L; P < 0.001) compared with the control group.

It's good to see researchers investigate these different relationships.

Erectile dysfunction: higher estradiol

Delayed ejaculation: lower estradiol

Premature ejaculation: higher testosterone

 

[Michael Scally MD]

[OA] From Erectile Dysfunction to Brain Subependymoma: A Case Report

Endocrinopathies are relatively rare causes of erectile dysfunction. Cases of hyperprolactinemia and pituitary adenomas have been previously reported. We present a clinical case of a 27-year-old male with suspected infertility and recent symptoms of erectile dysfunction. Additional radiological and endocrinologic workup revealed underlying subependymoma, which was expanding in the sellar and suprasellar regions, causing pressure against the pituitary gland.

The resulting endocrine disorder caused problems that were subjectively at first manifested mainly as erectile dysfunction. The case is an educative example pointing to the need of taking possible intracranial lesions in consideration when starting workup in a patient presenting with erectile dysfunction. It may be of broad clinical interest not only for endocrinologists but also for practitioners in various fields.

Bačun T, Kibel A, Degmečić D, Pavić R. FROM ERECTILE DYSFUNCTION TO BRAIN SUBEPENDYMOMA: A CASE REPORT. Acta Clin Croat. 2020;59(1):173-176. doi:10.20471/acc.2020.59.01.22 FROM ERECTILE DYSFUNCTION TO BRAIN SUBEPENDYMOMA: A CASE REPORT

 

[Michael Scally MD]

Novel Predictive Risk Factor of Erectile Dysfunction: Serum 25-Hydroxy Vitamin D

The present study aimed to investigate the association between the severity of erectile dysfunction (ED) and serum 25-hydroxy vitamin D. It also sought to determine the cut-off level of serum 25-hydroxy vitamin D for ED. This study included 130 men who had ED between 2018 and 2019.

Patients were divided into three groups according to their scores on the international index of erectile function-5 (IIEF-5) Turkish validated short form questionnaire. The serum 25-hydroxy vitamin D results were compared between the groups.

The mean age of the patients was 49.28 ± 13.62 years. Groups 1, 2 and 3 included 44 (33.8%) patients with severe ED, 56 (43.1%) patients with moderate ED and 30 (23.1%) patients with mild ED, respectively. Statistical significance was observed between the groups and serum 25-hydroxy vitamin D levels.

A positive correlation was detected between the IIEF-5 scores, serum testosterone and serum 25-hydroxy vitamin D levels. A cut-off level for serum 25-hydroxy vitamin D was calculated as 27.32 ng/ml.

During multivariate analysis, we found that serum 25-hydroxy vitamin D levels were independent prognostic risk factors for decreased IIEF-5 scores. Decreased serum 25-hydroxy vitamin D levels were associated with decreased IIEF-5 scores. Therefore, vitamin D replacement therapy may improve symptoms.

Horsanalı MO, Eren H, Dil E, Caglayan A, Erdogan O, Ekren F. Novel predictive risk factor of erectile dysfunction: Serum 25-hydroxy vitamin D [published online ahead of print, 2020 Jul 29]. Andrologia. 2020;e13767. doi:10.1111/and.13767 Error - Cookies Turned Off

 

[Michael Scally MD]

Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function

Objectives: Here we examine the association between shift work sleep disorder (SWSD) and erectile dysfunction (ED) in shift workers.

Methods: Men presenting to a single andrology clinic between January 2014 and July 2017 completed validated questionnaires: International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and the nonvalidated SWSD Questionnaire.

Men were also asked about shift work schedule, comorbidities, phosphodiesterase 5 (PDE5) inhibitor use, and testosterone use. Serum total testosterone values were determined for each visit.

Linear regression was performed controlling for testosterone use, testosterone levels, PDE5 inhibitor use, age, and comorbidities to determine the effect of SWSD on ED as assessed using the IIEF.

Results: Of the 754 men completing questionnaires, 204 reported nonstandard shift work (begins before 7 am or after 6 pm, regularly extends out of that frame, or rotates frequently) and 48 were found to have SWSD using a screening questionnaire.

Nonstandard shift work alone did not result in worse IIEF-EF scores (P = .31), but those who worked nonstandard shifts and had SWSD demonstrated IIEF-EF scores 2.8 points lower than men without SWSD (P < .01). When assessing for the type of shift work performed, men who worked night shifts had IIEF-EF scores 7.6 points lower than men who worked during the day or evening (P < .01).

Testosterone use improved IIEF-EF scores for men with SWSD by 2.9 points, ameliorating the effect of SWSD on ED. However, baseline testosterone levels were not associated with worse erectile function in this cohort.

Conclusion: Men with SWSD have worse erectile function, with men who work night shifts having even poorer erectile function. These findings suggest that circadian rhythm disturbance may significantly impact erectile function. While testosterone therapy may partly reverse the effects of SWSD, shift work is a potential risk factor for ED and should be assessed for as part of the evaluation of men with ED.

Rodriguez KM, Kohn TP, Kohn JR, et al. Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function [published online ahead of print, 2020 Jul 28]. J Sex Med. 2020;S1743-6095(20)30712-8. doi:10.1016/j.jsxm.2020.06.009 Shift Work Sleep Disorder and Night Shift Work Significantly Impair Erectile Function - ScienceDirect