Background: Both serum testosterone (T) levels and erectile dysfunction (ED) are associated with systemic diseases in men and ED is the most common presenting symptom of hypogonadism.
Aim: To evaluate the association of serum total testosterone (TT) levels with cardiometabolic diseases in men with ED.
Methods: Serum endogenous TT levels were determined to evaluate their associations with cardiometabolic diseases in men with ED in outpatient clinics. Participants were divided into hypogonadal with TT < 350 ng/dL (12.1 nmol/L) and eugonadal groups, as well as into four equal quartiles based on TT levels. The Framingham risk score was used to estimate individual 10-year coronary heart disease (CHD) risk.
Main outcome measures: Cardiometabolic factors included obesity, diabetes mellitus (DM), hypertension (HT), dyslipidemia, and the Framingham risk score.
Results: From 2010 to 2021, a total of 4467 subjects with ED were consecutively recruited for this study, and 3909 subjects' (87.5%) data with a mean age of 53.0 ± 12.9 (20.0-88.0) years had data eligible for analysis. Testosterone levels declined with age and a higher body mass index (BMI) was associated with lower T levels across all age groups (P < .001). Compared to the eugonadal group, the hypogonadal group was older and had a higher BMI and more cardiometabolic diseases (all P < .01). In multivariate analysis, odds ratio (OR) for hypogonadism was highest in men with obesity (2.51), followed by age group of ≥70 years (2.32), DM (1.59), HT (1.41), and dyslipidemia (1.26). Compared with the lowest TT quartile, higher quartiles of TT had significantly lower risk for cardiometabolic diseases (all P < .001). Among men over 50 yrs, hypogonadal men had a higher 10-year CHD risk than eugonadal men as predicted by the Framingham risk score (P < .001).
Clinical implications: Our results highlight the value of determining TT levels in men with ED because of their association with cardiometabolic diseases and the potential benefits of T therapy for improving men's health.
Strengths and limitations: Strengths of this study include a relatively large sample and detailed medical history collection. Limitations included a small portion of subjects with repeat TT tests, and the lack of data on free T and bioavailable T levels, and single-site recruitment.
Conclusions: TT levels are independently associated with cardiometabolic diseases including obesity, DM, HT, and dyslipidemia, and indicate a higher risk for CHD in men with ED. Measuring TT levels in men with ED presents an opportunity to improve overall health and reduce CV risk.
Background: Increasing evidence suggests that a diet rich in antioxidants may prevent erectile dysfunction (ED), but the impact of comprehensive dietary antioxidants on ED has been little studied.
Aim: To investigate the association between the composite dietary antioxidant index (CDAI) and ED risk in adult men.
Methods: The study performed a cross-sectional analysis using data from the 2001-2004 National Health and Nutrition Examination Survey to investigate the association between the composite dietary antioxidant index (CDAI) and ED. The connection between the CDAI and ED was assessed using univariate and multivariate weighted logistic regression models, as well as the restricted cubic spline.
Outcomes: Association between the CDAI and the prevalence of ED.
Results: The study included a total of 3699 participants, among whom 1042 were diagnosed with ED, resulting in a prevalence of 28.17%. Multivariate weighted logistic regression consistently showed a negative association between the CDAI and ED (OR = 0.95, 95% CI: 0.92-0.98, P = .005). The group with the highest CDAI (Q4) had a 33% reduced risk of ED than the group with the lowest CDAI (Q1) when the CDAI was regarded as a categorical variable (OR = 0.67, 95% CI: 0.49-0.91, P = .014). Restricted cubic spline analysis showed that the CDAI was linearly related to the risk of ED (non-linearity P = .652). Furthermore, subgroup analysis indicated that the inverse relationship between CDAI and ED was more pronounced in individuals under 60 years of age, those with diabetes, and those without hypertension.
Clinical implications: Dietary strategies to increase antioxidant intake might offer a potential approach to reducing ED risk and supporting men's sexual health.
Strengths and limitations: This is a large-scale study investigating the association between the CDAI and ED. However, as a cross-sectional study, the timeliness of the dataset and the recall bias inherent in dietary data somewhat limit the reliability of the results.
Conclusion: This study identified a significant inverse association between the CDAI and ED risk among adult men in the United States; however, as a cross-sectional study, this research cannot establish causation, and further longitudinal studies are needed to validate these findings and provide more definitive evidence.
Background: Currently, the treatment and prevention of erectile dysfunction (ED) remain highly challenging.
Aim: This study conducted a systematic druggable genome-wide Mendelian randomization (MR) analysis to identify potential therapeutic targets for ED.
Methods: A proteome-wide MR approach was employed to investigate the causal effects of plasma proteins on ED. Subsequently, summary data-based MR (SMR) analysis was performed to identify potential drug targets for ED. Enrichment analysis and protein-protein interaction (PPI) networks revealed the functional characteristics and biological relevance of these potential therapeutic targets. Drug prediction and molecular docking studies were conducted to validate the pharmacological activity of these identified targets. Finally, a systematic MR analysis was conducted to assess upstream intervention factors, such as lifestyles and diseases, associated with these targets, providing insights for the prevention and treatment of ED.
Outcomes: This study identified several potential therapeutic targets for ED.
Results: Proteome-wide MR analysis revealed that 126 genetically predicted plasma proteins were causally associated with ED. SMR analysis indicated that TMEM9 was associated with an increased risk of ED, while MDH1, NQO1, QDPR, ARL4D, TAGLN2, and PPP1R14A were associated with a decreased risk of ED. These potential targets were primarily enriched in metabolic and redox-related biological processes. Molecular docking indicated that the predicted drugs had favorable binding affinities with the proteins, further confirming the pharmacological value of these targets. Finally, 6 plasma proteins (MDH1, NQO1, QDPR, ARL4D, TAGLN2, and TMEM9) could be modulated by lifestyle- and disease-related factors.
Clinical implications: This study provides new insights into the etiology and potential drug targets of ED and contributes to the development of more effective treatments for ED and reducing the cost of drug development.
Strengths and limitations: This is a systematic and extensive study exploring the causal relationship between plasma proteins and ED, which helps to provide a comprehensive perspective to understand the role of potential targets in ED. However, we did not conduct this study in different types of ED or different stages of ED progression.
Conclusion: In summary, this study identified 7 plasma proteins causally associated with ED and provided new insights into the etiology and potential drug targets for ED.
Background: Diabetic erectile dysfunction (DMED) has a high incidence and is poorly treated.
Aim: This study investigates fibrosis's genetic profiling and explores potential mechanisms for DMED.
Methods: The DMED model was constructed in rats using streptozotocin. Erectile function was quantified using cavernous nerve electrostimulation. Fibrosis was evaluated using Masson's staining. RNA-seq was employed to analyze differentially expressed genes and fibrosis-related genes (FRGs) were acquired. Function enrichment analyses were performed, and genetic interaction was analyzed. Hub FRGs were screened using machine learning algorithms and Cytoscape tools and validated in Gene Expression Omnibus databases. Moreover, biological roles and subpopulation distribution of hub FRGs were determined.
Outcomes: Fibrosis-related genetic functions may play a vital role in DMED.
Results: Based on comprehensive analysis, 45 differentially expressed FRGs were identified. These genes participate in regulating smooth muscle cell proliferation, vasoconstriction, and collagen-associated activities. Final analyses identified and validated a core gene signature comprising TIMP1, BMP7, and POSTN. They were closely associated with diabetic complications-related signaling pathways and extracellular matrix-receptor interaction.
Clinical translation: The identified fibrosis-related gene signature may serve as the novel biomarkers for treating DMED.
Strengths and limitations: The study is the first to investigate the genetic profiles behind fibrosis and DMED using comprehensive approaches. However, the validation is not adequate and more animal experiments are needed.
Conclusion: The gene profiling and biological functions of FRGs in DMED were identified. These results broaden the understanding of fibrosis in DMED.
Background: The International Index of Erectile Function (IIEF) stands out for its utility and widespread use to measure sexual function in men. However, it lacks consistency in its internal latent structure across studies, has not been evaluated for measurement invariance, and has not undergone psychometric validation for its 15-item form in Spanish among South American countries.
Aim: To examine the IIEF's psychometric evidence (ie, structural/criterion validity and reliability) in a sample of adult men and determine its measurement invariance across relationship status (single vs in a relationship) and age generations (generations Z, Y/millennials, and X).
Methods: A sample of 650 sexually active males was derived from a broader Chilean study (Chilean Sex and Sexuality Study). We used a confirmatory factor analysis to determine the IIEF's structural validity, sexual satisfaction dimensions to establish its criterion-related validity, and Cronbach alpha and McDonald omega to assess the reliability of its scores.
Outcomes: Measures of goodness of fit.
Results: The evidence supported the 5-factor latent solution. Meanwhile, criterion-related validity revealed subtle yet significant differences in sexual satisfaction, with younger men displaying higher satisfaction in various sexual domains. In contrast, middle-aged men and those in a relationship showed better sexual function. Finally, the IIEF was invariant across age groups and relationship status at the factor covariance level.
Clinical translation: This study provides evidence that the IIEF is a valid, reliable, and invariant tool for the clinical practice in men's sexual health, particularly that associated with their sexual function and dysfunction.
Strengths and limitations: The study included a comprehensive validity analysis of the IIEF's psychometric properties, demonstrating its reliability and validity across diverse Chilean male subpopulations. The study also offered the IIEF's first assessment of measurement invariance and confirmed its suitability for clinical and research use in the Chilean population. Meanwhile, the study's limitations include a lack of clinical population and a sample predominantly younger, cisgender, and heterosexual.
Conclusion: Our study provides evidence of the IIEF's 5-factor structure and measurement invariance across age generations and relationship status in Chilean men, supporting its validity for clinical use and research and broadening its applicability in global sexual health studies, particularly in the Spanish-speaking South American male population.
Background: Sexual dysfunction (SD) due to Selective Serotonin Reuptake Inhibitors (SSRI) use is a common condition encountered by psychiatrists and its etiology has not been fully elucidated.
Aim: To determine the relationship between alpha Melanocyte Stimulating Hormone (α-MSH) and Melanocortin-4 receptor (MCR4) levels and sexual function levels of patients with and without SSRI related SD and control group and to examine whether α-MSH and MCR4 play a role in the etiology of SSRI related SD.
Methods: A total of 92 patients and 49 healthy volunteers who applied to psychiatry outpatient clinic were included in the study. Sociodemographic form, sexual history form, Structured Clinical Interview for DSM 5, Psychotropic Related Sexual Dysfunction-Turkish version (PreSexDQ-T), Arizona Sexual Experiences Scale, Beck Depression and Anxiety Inventory were used in the evaluation interview with the referred patients. Patient groups were formed according to whether there was SSRI related SD according to the sexual history and PreSexDQ-T scale.
Outcomes: The α-MSH and MCR4 levels were significantly lower in patients with SD due to SSRI use.
Results: α-MSH and MCR4 levels were lower in the SSRI related SD (SSRI-SD (+)) group than in the not experiencing SD with SSRIs (SSRI-SD (-)) and control groups. The mean α-MSH and MCR4 value of the control group was found to be significantly higher than the SSRI-SD (+) patient group, the mean MCR4 value of the control group was found to be significantly higher than the mean MCR4 value of the SSRI-SD (-) patient group. The mean MCR4 and a-MSH values of the SSRI-SD(+) group using SSRI with fluoxetine were significantly lower than the SSRI-SD (-) group using SSRI with fluoxetine.
Clinical implications: There is a role for α-MSH and MCR4 in SSRI related SD.
Strengths and limitations: Its strength is that it is the first human study in this field. Limitations include small sample size and unknown baseline levels of α-MSH and MCR4.
Conclusion: The fact that α-MSH and MCR4 play a role in the etiology of SD due to SSRI use in woman and that there was a significant difference between SSRI-SD (+) and SSRI-SD (-) groups when α-MSH and MCR4 levels were compared in fluoxetine users supports the hypothesis that serotonin may mediate SD via α-MSH and MCR4 through 5-hydroxytryptamine-2C (5-HT2C) antagonism.
Introduction: Clitoral priapism is persistent clitoral engorgement without sexual stimulation. Presentation is sparse, and therefore limited treatment options have been investigated.
Aim: We present a case report of a 34-year-old female presenting with persistent nonischemic clitoral priapism 5 years after aggressive clitoral stimulation.
Methods: Patient underwent six weekly Li-ESWT sessions at frequency 4 Hz, energy 0.11 mJ for 2000 shocks per session. Assessment included physical examination of clitoral glans engorgement and retraction, global response assessment (GRA) score, need for topical phenylephrine, and ability to achieve orgasm.
Results: At the end of the therapy, examination revealed complete resolution of priapism with a normal-appearing clitoris fully retracted behind the clitoral hood. The patient reported no longer requiring topical phenylephrine, a significant improvement in GRA, and the ability to achieve orgasm.
Conclusion: We present a case of nonischemic clitoral priapism resolved with Li-ESWT. More investigation regarding the utilization of Li-ESWT in the treatment of clitoral priapism is highly encouraged.
Background: Individuals from all over the world are increasingly using the internet to purchase sex toys and gadgets to enhance their sexual experience and provide variety and excitement to their sexual encounters.
Aim: This study examined the trends about the most popular preferred sex toys by nation/region from 2009 using data from Google Trends (GT).
Methods: GT was used to generate a "line-graph" that displays how interest in a topic in certain places has risen or diminished over time. Search terms were generated for vibrator, dildo, anal plug, strap-on, and masturbator. The data were included "globally" from January 1, 2009 to June 30, 2023.
Outcomes: The search values for certain terms were indexed using the relative search volume (RSV), which is shown on a scale of 0-100.
Results: In the linear regression analysis, the trends by strength were sorted as follows: dildo, vibrator, strap-on, anal plug, and masturbator. In 2018, vibrator surpassed strap-on and came in second, while the regression analysis showed a positive trend for dildo between 2009 and 2016 (P = .014). It had a negative trend after 2016. Strap-on was the only one to have a downward trend (P = .029). Regression analysis revealed positive trends for vibrator and masturbator (P = .030, P = .045). The upward trends have continued uninterruptedly since 2009.
Clinical implications: According to our research, interest in online trends relating to sex toys has increased along with advancements in technology and clinical applications. This rise is linked to the worldwide sex toy industry's development in response to consumer demand and ease of accessibility.
Strengths and limitations: This is the first research of this sort, looking into the interests of internet users about sex toys by country over time using GT. GT data is anonymous, and analysis of subpopulation groups is not possible.
Conclusion: Individual preferences for sex toys have different trends on different continents around the world. The compatibility of sex toys with technology over time, their clinical use, and sex toy-related injuries play an important role in the selection process. Web trends seem appropriate to reflect how the demand for sex toys has changed over time.
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