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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Erectile dysfunction affects many men in the United States. A 34% prevalence is estimated among male family practice patients. It is associated with a loss of self-image, self-confidence, and even chronic anger. Several risk factors increases the risk of erectile dysfunction. Prevalence is increased by 20-40% in patients with diabetes, hypertension, and those over 65 years old. While erectile dysfunction is generally acknowledged as an important health problem, misconceptions remain as to the need for clinician-initiated discussion regarding the issue. A retrospective chart review of patients at three health clinics in a predominately rural area was conducted. Subjects (n = 102) were those at risk of erectile dysfunction who had undergone a complete physical exam between October 1995 and December 1996. All physician encounters were examined for documentation of physician inquiry about erectile dysfunction. A survey of physician perceptions on initiating discussions of erectile dysfunction was also conducted. Physician-initiated discussion of erectile dysfunction was documented in 17% of patients with hypertension, 18% with diabetes mellitus, and 30% of patients > 65 years. The physician survey (11 respondents) showed 27% reported asking all male patients about erectile dysfunction at routine physical, while 45% reported asking 80% of their male patients. A 'lack of time' or belief that the 'patient will initiate discussions' was cited by several practitioners as reasons why inquiries were not initiated. All physicians in the study agreed that sexual function is an integral part of overall health. They either overestimated the percentage of patients asked about erectile dysfunction or they had not documented results consistently.
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PMID:Physician attitudes and behaviour regarding erectile dysfunction in at-risk patients from a rural community. 1044 67

Arterial hypertension is associated with structural and functional alterations of the vessel walls. Because vascular endothelium plays a central role in the control of vascular tone, endothelial dysfunction can also cause certain types of erectile dysfunction. Erectile dysfunction is also a common side effect of certain drugs, including many antihypertensive agents. Physicians should be aware of potential sexual side effects of such drugs and take appropriate steps to alleviate persistent problems. Most important, physicians need to ask patients about sexual function and discuss the possibility of erectile dysfunction caused by antihypertensive therapy. Erectile dysfunction can be effectively treated in most patients, and many treatment options are available. Sildenafil therapy has revolutionized the management of this disorder, but this agent should be used with caution in certain patients taking nitrates.
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PMID:What is causing your patient's sexual dysfunction? Uncovering a connection with hypertension and antihypertensive therapy. 1045 46

With the introduction of effective pharmacologic therapies for erectile dysfunction, more men are seeking treatment. The underlying cause of erectile dysfunction is usually a chronic medical illness or a side effect of certain drugs. Less commonly, the problem is psychogenic. Even after optimal treatment of common medical disorders such as diabetes mellitus and hypertension, erectile dysfunction may persist. Pharmacologic treatments, such as the intracavernosal or transurethral administration of alprostadil or the use of the new oral medication sildenafil, may offer patients substantial benefit. Before any of these drugs are prescribed, consideration should be given to existing medical illnesses and medications, partner satisfaction, comfort with the method of administration and the side effect profile.
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PMID:Newer pharmacologic alternatives for erectile dysfunction. 1050 45

There is convincing evidence that the prevalence of erectile dysfunction is increased among men with ischaemic heart disease. This association may be attributed to the fact that both erectile dysfunction and ischaemic heart disease share similar risk factors (e.g. hypertension, dyslipidaemia, diabetes and smoking). Nitric oxide (NO) activity is adversely affected, in penile and vascular tissue, by these risk factors. It is therefore not surprising that a defect in NO activity is thought to play a role in the pathogenesis of both erectile dysfunction and ischaemic heart disease. We consider this evidence and propose that defective NO activity provides a unifying explanation for the association between these two conditions. Further research in this area may improve our understanding of the pathogenesis of cardiovascular diseases as a whole.
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PMID:Nitric oxide and penile erection: is erectile dysfunction another manifestation of vascular disease? 1069 Mar 37

Erectile dysfunction (E. D.) affects millions of men in the whole world. The prevalence of erectile dysfunction in the best conducted study, the Massachusetts Male Aging Study (MMAS), was 52% of male subjects aged 40 to 70 years. ED is strongly associated with age. Multiple risk factors, such as chronic illness, hypertension, diabetes, medication, operation in the pelvis, smoking and alcohol consumption, have a negative influence on erectile function.
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PMID:[Epidemiology and age-related risk factors of erectile dysfunction]. 1074 86

Erectile disfunction (E. D.) is more common in older men but may affect younger men too. Diabetes mellitus, coronary heart disease and hypertension are often associated with E. D. The majority of the patients are treated medically for erectile dysfunction and, recently, oral therapy has become most important since Viagra has been approved. New phosphodiesterase blockers are in preclinical evaluation since then. Phentolamine and apomorphine will become available soon for the treatment of E. D. It is important to know about the etiology of E. D. as well as the mechanisms by which drugs may improve erection in order to decide which drug is appropriate for a particular patient.
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PMID:[Oral therapy of erectile dysfunction]. 1074 89

Erectile dysfunction (ED) has been defined by the National Institutes of Health Consensus Conference in 1993 as the inability to achieve and/or maintain an erection adequate for penetration and completion of satisfactory intercourse.1 Erectile dysfunction, the preferred term, is more accurate and less pejorative than impotence.An estimated 20-30 million American men are affected with ED of varying degrees of severity. The Massachusetts Male Aging Study published in 1994 reviewed 1,211 men between the ages of 40 and 70; 52% reported ED with 9.6% having mild, 22.2% moderate, and 17.2% complete or severe ED.2 The National Health and Social Life Survey, authored by Laumann et al.,3 reviewed a population of men and women between the ages of 18 and 59. Of note, female sexual dysfunction exceeded male sexual dysfunction, with 43% of women complaining of sexual function problems. Interestingly, except for lubrication, this seemed to decrease with age in women. On the other hand, 31% of the men complained of sexual problems that increased with age.Erectile dysfunction is an age-dependent problem. Approximately 2% of men are affected at 40 years of age and about 25% or more at 65 years of age.4 However, ED is not an inevitable result of aging. Rather, as a man matures it is most likely that he will experience more of the neurovascular insults resulting in ED.The development of an erection and satisfactory sexual function is a complex process. As suggested by Melman et al.,5 "Erection is truly at least a sensory-motor-neuro-hormonal-vascular-psycho-social-cultural-interpersonal event." There are two main classifications of ED, psychogenic and organic. Current thinking suggests that up to 80% of ED is primarily of organic etiology. Yet, there is always a psychogenic factor.6 Erectile dysfunction may signal serious underlying and potential life-threatening diseases, such as diabetes, hypertension, cardiovascular disease, peripheral vascular disease, and other neurologic and endocrine disorders. Therefore, questions regarding sexual function should be part of routine medical evaluation.
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PMID:Erectile dysfunction: a review of a common problem in rapid evolution. 1084 Feb 16

A study of the prevalence rate of erectile dysfunction (ED) in the Thai population has never been done previously, except for a small study in the hospital. The project was carried out across the whole country, including in the north, south, eastern and central plains, and there were representatives from one small and one large province and the Bangkok metropolitan area. There were 250 males in each area, giving as total of 1250 males. The interviews were carried out in urban areas, so that the questions and answers could produce good data. The interviewer was trained by one of our EDACTT members, before going to the interview locations, and the supervisor were also onsite to clarify any the questions that might occur. The questions and pretest were carried out stringently, to help in term of statistics. All the health questions were asked taking care to accommodate the interviewee's feelings, so as not to cause embarrassment. The interviews were held individually and strictly privately, so that the interviewees could speak freely The interviewees were between 40 and 70-years old, to match with MMAS. The rate of ED in this age group is increasing gradually, and the relationship between ED and hypertension, diabetics or heart disease, and lifestyle factors, including smoking habits, alcohol consumption, caffeine and risk factors is of interest.
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PMID:Prevalence of erectile dysfunction in Thailand. Thai Erectile Dysfunction Epidemiological Study Group. 1084 2

The conditions of depression, erectile dysfunction (ED), and cardiovascular disease may seem at a superficial level as independent medical problems managed by 3 separate and unrelated healthcare disciplines. Various studies, however, have revealed significant associations between depression and cardiovascular disease, ED and cardiovascular disease, and depression and ED. The purpose of this research was to identify whether the 3 medical conditions share mutually reinforcing associations and predictors. Population-based epidemiologic studies were utilized where possible. Variables including age, heart disease, hypertension, sedentary behavior, related medications, cigarette smoking, and abnormal lipids have been found to be highly associated with depressive symptoms, cardiovascular disease, and ED. It was concluded that all 3 medical conditions share many of the same risk factors and etiologic associations and may be best modeled in a 3-way holistic, mutually reinforcing relation. Of particular relevance, patients with sexual dysfunction have a likely comorbidity of cardiovascular disease and depression, as well as the potential increased risk for cardiac morbidity and mortality.
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PMID:The mutually reinforcing triad of depressive symptoms, cardiovascular disease, and erectile dysfunction. 1089 78

Sildenafil citrate is the first oral agent approved for the treatment of erectile dysfunction (ED); other oral agents are in the process of development. Because the mechanism of action of many of these agents involves vasodilation, there is a potential for interaction with the cardiovascular system. Sildenafil inhibits phosphodiesterase-5 (PDE-5) which is found in the corpus cavernosum and in the systemic vasculature. Sildenafil causes a mild decrease in systemic arterial pressure ( approximately -8/-5.5 mm Hg); it causes a synergistic and often major decrease in systemic arterial pressure in the presence of organic nitrates (nitric oxide donors). Sildenafil is therefore contraindicated in patients taking organic nitrates. A review was made of clinical trials in populations of men with (1) erectile dysfunction; (2) chronic stable ischemic heart disease and erectile dysfunction; and (3) hypertension and erectile dysfunction. This review showed that sildenafil was effective and not associated with an increase in serious cardiovascular adverse events, myocardial infarction (MI), or death compared with placebo. Although there have been spontaneous reports of death among men using sildenafil, there are limitations to spontaneous-event reporting. In addition. the numbers of such reports are well below the expected numbers of deaths when considering the number of men who have received prescriptions for sildenafil and their age and cardiovascular risk factor profile. Because there is a small but finite risk of having a cardiac event with sexual activity, physicians should discuss with their cardiac patients the risks of sexual activity before prescribing any treatment for ED. In addition, they should evaluate their patients' cardiac status when considering the safety of administering any ED treatment that may have systemic vasodilatory properties and can potentially lower blood pressure. In some cases, exercise treadmill testing may be warranted to determine whether ED patients with coronary artery disease can achieve the physiologic workload (4-6 metabolic equivalents) associated with sexual intercourse.
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PMID:Cardiovascular risk and sildenafil. 1089 81


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