In a study published in the February 2007 issue of The American Journal of Medicine, researchers report that erectile dysfunction was significantly and independently associated with age, cardiovascular disease, diabetes, and lack of physical activity. There was an especially high prevalence of erectile dysfunction among men with hypertension and diabetes, suggesting that screening for erectile dysfunction in these patients may be warranted. Researchers from the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Hospital analyzed data from 2126 men who participated in the 2001-2002 National Health and Nutrition Examination Survey (NHANES).

As many as 18 million men may be affected with erectile dysfunction in the United States. The recent development of effective oral medications to treat erectile dysfunction has raised awareness and furnished treatment options, however lifestyle changes like increase of physical activity, stricter dietary control and other measures for the prevention of cardiovascular disease and diabetes may prevent decrease in erectile function.

The study was undertaken to assess the prevalence of erectile dysfunction in the general U.S. male population overall and by age; to assess the prevalence of cardiovascular risk factors among individuals with erectile dysfunction; and to determine associations of cardiovascular risk factors, including lack of physical activity with prevalent erectile dysfunction. Prevalence estimates from this study are nationally representative of the noninstitutionalized adult male population in the United States.

Using data obtained from a computer-assisted self-interview in a private room, the authors found that 18.4% of men 20 years and older experienced erectile dysfunction, defined as “sometimes able” or “never able” to get and keep an erection. Demographic data, cardiovascular risk factors and levels of physical activity were extracted from the NHANES study.

Writing in the article, investigator Elizabeth Selvin, PhD, MPH, states, “The association between erectile dysfunction and lack of physical activity suggests that lifestyle changes, especially increasing exercise level, may be effective nonpharmacological treatments. The associations between erectile dysfunction and diabetes and other known cardiovascular risk factors should serve as powerful motivators for male patients for whom diet and lifestyle changes are needed to improve their cardiovascular risk profile. These data suggest physical activity and other measures for the prevention of cardiovascular disease and diabetes may prevent decrease in erectile function.”

The study is “Prevalence and Risk Factors for Erectile Dysfunction in the US” by Elizabeth Selvin, PhD, MPH, Arthur L. Burnett, MD, and Elizabeth A. Platz, ScD, MPH. It appears in The American Journal of Medicine, Volume 120, Issue 2 (February 2007), published by Elsevier.

Source: Elsevier Health Sciences (2007, February 13). Lifestyle Changes Can Improve Male Sexual Function, According To New Study. ScienceDaily. Retrieved November 8, 2009, from http://www.sciencedaily.com­ /releases/2007/02/070201082333.htm

A preeminent cardiologist reports, for the first time in a large prospective study, that certain of his patients with erectile dysfunction (ED) and heart problems can now safely use erection drugs that help up to 80% of men restore function and quality of life.

Dr. Graham Jackson, who established a unique clinic inEngland dedicated to providing sexual advice to men with cardiac disease and ED, conducted the largest scientific study of its kind, on 425 men with ED and cardiac disease. In the study, appearing in the July issue of The Journal of Sexual Medicine, Dr. Jackson wished to see if stable coronary patients with ED could have their oral nitrates discontinued to allow for safe use of a PDE-5 inhibitor, such as Viagra, Levitra or Cialis.

More than half of the men on oral nitrates who were clinically stable with good ability to exercise had their nitrates discontinued in the presence of continuing beta-blockade or calcium antagonist therapy and close follow-up. Over 90% of the men no longer taking nitrates were treated with a PDE-5 inhibitor which was effective in restoring sexual function in 85%. Importantly, there have been no adverse cardiac events in the group.

“This is a huge, groundbreaking advance in our field that shows how multidisciplinary sexual medicine really is,” states Irwin Goldstein MD, Editor-in-Chief of The Journal of Sexual Medicine. “Coordinating care between the sexual medicine physician and the cardiologist has provided new evidence-based, prospective data to support better clinical care for those men with ED and cardiac disease, who historically have been denied such care. We now know that oral nitrates can be discontinued in the presence of continuing beta blockade and/or calcium antagonist therapy in stable coronary disease patients with ED to allow for the safe use of PDE-5 inhibitors.”

The Center for Disease Control and Prevention estimates that 1 in 12 (8%) or 22 million adults in the US have heart disease. In the US, the prevalence rate for those who have angina pectoris is 17.5 per 1000 people. Nitrate therapy is an absolute contraindication to the use of PDE-5 inhibitors, however, since oral nitrates confer little benefit when added to optimum doses of betablockers and/or calcium antagonists, it followed that stable patients may be able to have their nitrate therapy discontinued or exchanged for a drug that does not react with a PDE-5 inhibitor, such as a calcium antagonist or beta blocker.

“If you are on nitrates, the best advice is to see your doctor,” says Dr. Goldstein.

Source: Blackwell Publishing Ltd. (2005, June 28). Vascular Disease Most Common Cause Of Male Erectile Dysfunction. ScienceDaily. Retrieved November 8, 2009, from http://www.sciencedaily.com­ /releases/2005/06/050627233921.htm

The American College of Physicians has issued recommendations for the treatment of erectile dysfunction (ED). ACP strongly recommends that physicians initiate therapy with an oral phosphodiesterase type 5 (PDE-5) inhibitor in men who seek treatment for ED unless they have a contraindication to PDE-5 inhibitors, such as nitrate therapy. As for which PDE-5 inhibitor to use, ACP recommends that physicians base the choice on the individual preferences of patients including ease of use, cost of medication, and adverse effects profile.

“The evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials,” explained the lead author of the guideline, Amir Qaseem, MD, PhD, MHA, FACP, senior medical associate at the American College of Physicians.

The guideline authors analyzed evidence gathered from 130 randomized controlled trials that evaluated oral PDE-5 inhibitors alone or combined. Treatment with a PDE-5 inhibitor resulted in statistically significant and clinically relevant improvements in sexual intercourse and erectile function in patients with ED, regardless of the cause (e.g., diabetes, depression, prostate cancer) or baseline severity.

Overall, the evidence showed that PDE-5 inhibitors were relatively well-tolerated and were associated with mild or moderate adverse effects, such as headaches, flushing, upset stomach, and runny nose.

ACP does not recommend for or against routine hormonal blood tests or treatment in the management of patients with ED because the evidence is inconclusive about the effectiveness in patients with low testosterone levels. Physicians should individualize decisions to measure hormone levels based on the clinical symptoms (e.g., decreased libido, premature ejaculation, fatigue, etc.) and physical findings (for example, testicular atrophy, muscle atrophy) that suggest hormonal abnormality.

About ED

ED can be a persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million in the U.S., depending on the definition used. Estimates from the National Health and Nutrition Survey suggested that the cost of treatment of ED in the U.S. could reach $15 billion if all men sought care.

ED is a common disorder of male sexual function and affects all age groups especially individuals with advanced age, diabetes, vascular diseases, psychiatric disorders, and possibly hypogonadism (low testosterone). ED may be caused by chronic diseases such as obesity, hypertension, dyslipidemia, cardiovascular disease, or smoking; medications; psychosocial factors; or hormonal abnormalities.

ED lasting for three months is considered a reasonable length of time to warrant evaluation and consideration of treatment.

Source: American College of Physicians (2009, October 19). Erectile Dysfunction: Treatment With Oral Medications Demonstrates Significant Improvements In Sexual Intercourse And Erectile Function. ScienceDaily. Retrieved November 8, 2009, from http://www.sciencedaily.com­ /releases/2009/10/091019172057.htm

Men who smoke cigarettes run an increased risk of experiencing erectile dysfunction, and the more cigarettes smoked, the greater the risk, according to a study by Tulane University researchers published in the American Journal of Epidemiology.

A team of researchers led by Jiang He, Professor of Epidemiology at the Tulane University School of Public Health and Tropical Medicine, examined the association between cigarette smoking and erectile dysfunction in a 2000-2001 study in China involving 7,684 men. The researchers used questionnaires to assess the status of cigarette smoking and erectile dysfunction. Those surveyed were men between the ages of 35-74 who did not have vascular disease.

The team found that there was a significant statistical link between the number of cigarettes that men smoked and the likelihood they would experience erectile dysfunction. The association between smoking and erectile dysfunction was even stronger in participants with diabetes. An estimated 22.7 percent of erectile dysfunction cases among Chinese men might be attributable to cigarette smoking, says the study.

Although erectile dysfunction is not a life-threatening condition, it compromises well-being and quality of life. The Tulane study results suggest that smoking prevention should be an important approach for reducing the risk of erectile dysfunction.

Source: Tulane University (2007, August 1). Erectile Dysfunction Linked To Smoking. ScienceDaily. Retrieved November 8, 2009, from http://www.sciencedaily.com­ /releases/2007/07/070727153458.htm

ScienceDaily (Sep. 20, 2009) — An innovative drug-delivery system – nanoparticles encapsulating nitric oxide or prescription drugs – shows promise for topical treatment of erectile dysfunction (ED), according to a new study by scientists at Albert Einstein College of Medicine of Yeshiva University.

The new system, tested successfully on a small number of animals, could potentially prevent side effects associated with oral ED medications, if study results can be replicated in humans. That could mean safer and more effective ED therapy for millions of men with heart disease and other health problems affecting erectile function. The study is published today in the online edition of the Journal of Sexual Medicine.

Tens of millions of men worldwide have benefited from oral ED medications such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). However, these medications – which belong to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors – have limitations. They can cause systemic side effects that can be serious. These side effects include headache, facial flushing, nasal congestion, upset stomach, abnormal vision as well as isolated reports of hearing and vision loss. Men who’ve recently suffered a heart attack or stroke or have severe heart disease should use these drugs with caution or not at all. In addition, “an estimated 30 to 50 percent of men with ED do not respond to oral use of PDE5 inhibitors,” says senior author Kelvin P. Davies, Ph.D., associate professor of urology at Einstein.

The drug-delivery system, developed by Einstein scientists, consists of nanoparticles – each smaller than a grain of pollen – that can carry tiny payloads of various drugs or other medically useful substances and release them in a controlled and sustained manner.

The limited number of topical formulations of ED drugs has so far proven ineffective. This study was done to evaluate whether the Einstein nanoparticles, which have been shown to penetrate the skin, might allow the targeted delivery of compounds that treat ED and thereby avoid the drugs’ systemic effects.

An effective topical therapy could be especially significant for those ED patients – particularly men with diabetes – who have reduced levels of nitric oxide (NO), the signaling molecule that dilates blood vessels responsible for erectile activity. These men, who often aren’t helped by oral PDE5 inhibitor drugs, may benefit from direct application of NO or the PDE5 inhibitors.

The nanoparticles were tested on a total of 18 rats bred to have age-related ED. The rats were divided into three treatment groups. One group of seven rats received nanoparticles encapsulating NO. A second group of five rats received nanoparticles encapsulating NO plus an experimental ED drug called sialorphin (which has a mechanism of action different from PDE5 inhibitors). A third group of six received nanoparticles encapsulating NO plus tadalafil (Cialis).

Five of the seven rats treated with the NO-containing nanoparticles, and all 11 rats treated with nanoparticles encapsulating NO plus sialorphin or tadalafil showed significantly improved erectile function. None of the seven rats in a control group, which received empty nanoparticles, showed any improvement.

“Most of the animals, nearly 90 percent, showed a response to treatment with the nanoparticles,” says co-author Joel M. Friedman, M.D., Ph.D., professor of physiology & biophysics and of medicine. Dr. Friedman developed the nanoparticles with his son Adam Friedman, M.D., chief resident in the division of dermatology of the department of medicine at Montefiore Medical Center, The University Hospital and Academic Medical Center for Einstein.

“The response time to the nanoparticles was very short, just a few minutes, which is basically what people want in an ED medication,” adds Dr. Davies. “In both rats and humans, it can take 30 minutes to one hour for oral ED medications to take effect.”

Postmortem examination of the tissues at the site of administration showed no signs of local inflammation or toxicity. “In addition, when we applied the nanoparticles at therapeutic doses, we found no indication of systemic side effects,” says Dr. Friedman.

The Einstein research team will carry out safety and dosing studies in rats in the coming months. Clinical studies on humans could begin in a few years if animal studies continue to show that the nanoparticle delivery system is safe and effective. But the investigators caution that the time from a proof-of-concept trial in animals to approved use in humans may be a decade or more.

The paper, “Nanoparticles as a novel delivery vehicle for therapeutics targeting erectile dysfunction,” is published in the September 18, 2009 online edition of the Journal of Sexual Medicine. The lead authors are George Han, an M.D.-Ph.D. student at Einstein, Moses Tar, M.D., assistant professor of urology at Einstein, Dwaraka Srinivasa Rao Kuppam, a technician in the Einstein urology department, Adam Friedman, M.D., of Montefiore Medical Center, and Arnold Melman, M.D., chairman of urology at Einstein, also contributed to the research.

Men in their fifties are more satisfied with their sex lives than men in their thirties and forties, recording similar levels to 20-29 year-olds, according to a survey published in the February issue of BJU International.

A team of experts from Norway and the USA surveyed 1,185 men aged between 20 and 79, asking them about various aspects of their sex life, including drive, erections and ejaculation.

They found that although there was a strong relationship between a man’s advancing age and his declining sex drive and ability to have an erection and ejaculate, there wasn’t such a strong link between age and overall sexual satisfaction.

The men who responded to the Norwegian postal questionnaire were asked to rate their satisfaction with various aspects of their sex life on a scale of zero to four, with four representing good sexual function and no problems. Men in their twenties recorded an average overall satisfaction level of 2.79 and the second highest level was among fifty-somethings who recorded an average of 2.77. Men in their 30s only reached 2.55 and men in their forties averaged 2.72.

After the age of 59, overall satisfaction fell significantly to 2.46 for men in their sixties and 2.14 for men in their seventies.

However when it came to sexual function, each of the scores moved steadily downwards toward zero as the respondents got older, indicating lower levels of function and more problems:

• The average score for sexual drive was 2.19 out of four, ranging from 2.79 for men in the twenties to 1.54 for men in their seventies.
• Satisfaction with erections averaged 2.83, dropping sharply once men reached their fifties. Men in their twenties scored 3.63, men in their fifties 3.03 and men in their seventies 1.60.
• Ejaculation averaged 3.28 and showed a more measured decline with age, falling more sharply for men in their sixties and seventies. Men in their twenties averaged 3.85 while men in their seventies averaged 2.32.

Other findings included:

• 86 per cent of the men surveyed were married or in a sexual relationship and 57 per cent had been sexually active in the last 30 days. Six per cent had had a new sexual partner in the last six months.
• 25 per cent were on medication for high blood pressure, five per cent for diabetes, six per cent for anxiety/depression and five per cent for erectile dysfunction.
• Respondents were representative of the Norwegian male population in terms of marital status and education level.

“The survey was carried out using a questionnaire first developed and tested in American in 1995″ says co-author Professor Sophie D Fossa from the Rikshospitalet-Radiumhospitalet Trust in Oslo, who carried out the research with colleagues from the University of Oslo, the University of Bergen and Harvard Medical School in the USA.

“The results showed a very strong correlation between men getting older and reduced sexual functioning, but not between age and sexual satisfaction” she points out.

“Age accounted for a 22 per cent variance in sexual drive, a 33 per cent variance in erection issues and a 23 per cent variance in ejaculation issues.

“But age only accounted for a variance of three per cent in overall satisfaction.

“Our results show that although men experience more problems and less sexual function as they get older, it doesn’t necessarily follow that they are less satisfied with their sex lives as a result.”

Assessment of male sexual function by the Brief Sexual Function Inventory. Mykletun, Dahl, O’Leary and Fossa. Norway / USA. BJU International. Volume 97, pages 316 to 323. (February 2006).

An increasing number of 70 year olds are having good sex and more often, and women in this age group are particularly satisfied with their sex lives, according to a study published on the British Medical Journal website.

Knowledge about sexual behaviour in older people (70 year olds) is limited and mainly focuses on sexual problems, less is known about “normal” sexual behaviour in this age group.

Nils Beckman and colleagues from the University of Gothenburg in Sweden, studied attitudes to sex in later life among four representative population samples of 70 year olds in Sweden, who they interviewed in 1971-2, 1976-7, 1992-3, and 2000-1. In total, over 1 500 people aged 70 years were interviewed about different aspects of their sex lives including sexual dysfunctions, marital satisfaction and sexual activity.

The authors found that over the thirty year period the number of 70 year olds of both sexes reporting sexual intercourse increased: married men from 52% to 68%, married women from 38% to 56%, unmarried men from 30% to 54%, and unmarried women from 0.8% to 12%.

In addition, the number of women reporting high sexual satisfaction increased, more women reported having an orgasm during sex and fewer reported never having had an orgasm.

While the proportion of women reporting low satisfaction with their sex lives decreased, the proportion of men reporting low satisfaction increased. The authors suggest that this might be because it is now more acceptable for men to admit “failure” in sexual matters.

They also note that the number of men reporting erectile dysfunction deceased, whereas the proportion reporting ejaculation dysfunction increased, but the proportion reporting premature ejaculation did not change.

Interestingly, both men and women blame men when sexual intercourse stops between them. This finding replicates the results of other studies in the 1950s and 2005-06.

“Our study…shows that most elderly people consider sexual activity and associated feelings a natural part of later life”, they conclude.

These findings emphasise the important and positive part sex plays in the lives of 70 year olds and is a welcome contribution to the limited literature about sexual behaviour in older people, writes Professor Peggy Kleinplatz from the University of Ottawa in Canada.

It will hopefully highlight the need for doctors to be trained to ask all patients, regardless of age, about their sexual concerns, she adds.

BMJ-British Medical Journal (2008, July 9). Sex Really Does Get Better With Age (Just Ask A 70 Year Old). ScienceDaily.

Satisfactory sexual intercourse for couples lasts from 3 to 13 minutes, contrary to popular fantasy about the need for hours of sexual activity, according to a survey of U.S. and Canadian sex therapists.

Penn State Erie researchers Eric Corty and Jenay Guardiani conducted a survey of 50 full members of the Society for Sex Therapy and Research, which include psychologists, physicians, social workers, marriage/family therapists and nurses who have collectively seen thousands of patients over several decades.

Thirty-four, or 68 percent, of the group responded and rated a range of time amounts for sexual intercourse, from penetration of the vagina by the penis until ejaculation, that they considered adequate, desirable, too short and too long.

The average therapists’ responses defined the ranges of intercourse activity times: “adequate,” from 3-7 minutes; “desirable,” from 7-13 minutes; “too short” from 1-2 minutes; and “too long” from 10-30 minutes.

“A man’s or woman’s interpretation of his or her sexual functioning as well as the partner’s relies on personal beliefs developed in part from society’s messages, formal and informal,” the researchers said. “”Unfortunately, today’s popular culture has reinforced stereotypes about sexual activity. Many men and women seem to believe the fantasy model of large penises, rock-hard erections and all-night-long intercourse. ”

Past research has found that a large percentage of men and women, who responded, wanted sex to last 30 minutes or longer.

“This seems a situation ripe for disappointment and dissatisfaction,” said lead author Eric Corty, associate professor of psychology. “With this survey, we hope to dispel such fantasies and encourage men and women with realistic data about acceptable sexual intercourse, thus preventing sexual disappointments and dysfunctions.”

Corty and Guardiani, then-undergraduate student and now a University graduate, are publishing their findings in the May issue of the Journal of Sexual Medicine, but the article is currently available online.

The survey’s research also has implications for treatment of people with existing sexual problems. “If a patient is concerned about how long intercourse should last, these data can help shift the patient away from a concern about physical disorders and to be initially treated with counseling, instead of medicine,” Corty noted.

Penn State (2008, April 2). Good Sexual Intercourse Lasts Minutes, Not Hours, Therapists Say. ScienceDaily

While fatherhood might be far from the minds of most young men, behavior patterns they establish early on may impact their ability to become a dad later in life. Excessive laptop use tops this list of liabilities, according to one reproductive specialist at Loyola University Health System (LUHS).

“Laptops are becoming increasingly common among young men wired into to the latest technology,” said Suzanne Kavic, MD, director of the division of reproductive endocrinology at LUHS and associate professor in the department of obstetrics and gynecology and department of medicine at Loyola University Chicago Stritch School of Medicine. “However, the heat generated from laptops can impact sperm production and development making it difficult to conceive down the road.”

Kavic recommends placing laptops on desktops to prevent damaging sperm and decreasing counts and motility. Other tips to protect male fertility include:

• Avoiding hot tubs
• Wearing boxers instead of briefs
• Refraining from ejaculating too frequently (the recommendation is to only engage in sexual intercourse every other day around ovulation)
• Exercising moderately (one hour, three to five times per week)
• Avoiding exercise that can generate heat or trauma to the genital area
• Eating well
• Taking a daily multivitamin
• Getting eight hours of sleep per night
• Staying hydrated and limiting caffeine to no more than two cups per day
• Refraining from smoking
• Avoiding drugs and excessive alcohol use
• Minimizing exposure to toxins
• Avoiding excessive weight gain or weight loss
• Practicing stress reduction techniques

Forty percent of fertility issues are attributed to males. Other leading causes of male infertility include varicocoeles or enlarged varicose veins in the scrotum. This condition can raise the temperature in the testicles and damage or kill sperm. Other reasons include genital injuries or defects, certain sexually transmitted infections, prostatitis (an infection or inflammation of the prostate), immune and hormonal disorders and erectile dysfunction. Kavic also notes that underlying health issues and medications may be to blame for fertility issues.

“Medications for depression, blood pressure and certain heart conditions may lower libido or cause impotence,” said Kavic. “Men should talk with their physicians to see if medication is necessary or if they can switch to another with fewer side effects.”

Reproductive endocrinology services available for males at LUHS include consultations, medical history and physical examinations, semen analysis, intrauterine inseminations by husband donor, assessments for the need for assisted reproductive technology and referrals to support services and alternative medicine.

“With Father’s Day around the corner, males should be reminded to take care of their health,” said Kavic. “An annual physical exam combined with a healthy lifestyle may make it easier to become a dad when the time is right.”

Loyola University Health System (2009, June 13). Laptops Linked To Male Infertility.

Erectile dysfunction gives a two to three year early warning of a heart attack, warns an expert on the British Medical Journal website.

But the link between erectile dysfunction and the risk of heart disease is being ignored by doctors, writes Dr Geoffrey Hackett from the Good Hope Hospital in Birmingham.

Over many years Hackett reports regularly seeing patients referred with erectile dysfunction after a heart attack, only to hear that they had developed erectile dysfunction two to three years before—a warning sign ignored by their general practitioners.

It is well known that erectile dysfunction (a symptom of vascular disease in the smaller arteries) doubles the risk of heart disease, a risk equivalent to being a moderate smoker or having an immediate family history of heart disease. Erectile dysfunction in type 2 diabetes has been shown to be a better predictor of the risk of heart disease than high blood pressure or high cholesterol.

But despite this considerable evidence erectile dysfunction is still treated as a recreational or “lifestyle issue” rather than a predictor of a serious health problem, says Hackett.

The UK government has pledged to reduce the death rate from coronary heart disease and stroke and related diseases in people under 75 by at least 40% by 2010, yet there is no screening for erectile dysfunction in patients with diabetes or heart disease, he says.

“Continuing to ignore these issues on the basis that cardiologists feel uncomfortable mentioning the word ‘erection’ to their patients or that they may have to deal with the management of a positive response, is no longer acceptable and possibly, based on current evidence, clinically negligent”, he concludes.

BMJ-British Medical Journal (2008, October 22). Erectile Dysfunction Gives Early Warning Of A Heart Attack, Warns Expert. ScienceDaily.