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Sexual problems in both sexes appear to be widespread in society, influenced by both health-related and psychosocial factors, and are associated with impaired quality of life. Epidemiological studies suggest that modifiable health behaviors, including physical activity and leanness, are associated with a reduced risk for erectile dysfunction (ED) among men. Data from other surveys also indicate a higher prevalence of impotence in obese men. Obesity may be a risk factor for sexual dysfunction in both sexes; the data for the metabolic syndrome are very preliminary and need to be confirmed in larger epidemiologic studies. The high prevalence of ED in patients with cardiovascular risk factors suggests that abnormalities of the vasodilator system of penile arteries play an important role in the pathophysiology of ED. We have shown that one-third of obese men with ED can regain their sexual activity after 2 y of adopting health behaviors, mainly regular exercise and reducing weight. Western societies actually spend a huge part of their health care costs on chronic disease treatment and interventions for risk factors. The adoption of healthy lifestyles can reduce the prevalence of obesity and the metabolic syndrome, and hopefully the burden of sexual dysfunction.
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PMID:Obesity, the metabolic syndrome, and sexual dysfunction. 1590 79

To expand our crosscultural understanding of erectile dysfunction, we investigated erectile dysfunction among Ariaal men, pastoral nomads of northern Kenya. To measure erectile dysfunction, we administered the International Index of Erectile Function (IIEF-5) to 198 men aged 20 y and older during interviews. Marital status and anthropometric measures of body composition were also obtained. Men were classified into 10-y age groups. ANOVA revealed that erectile dysfunction increases with age (P<0.0005), with men 60 y and older showing significantly higher erectile dysfunction compared with men in their 20s, 40s and 50s. In a MANCOVA model, erectile dysfunction increased with age group (P<0.001), was negatively related to right-hand grip strength (P<0.01) and negatively related to number of wives (P<0.05). In addition, there was a significant interaction between age group and marital status (P<0.01). Erectile dysfunction showed no independent relationship to measures of body composition, including body mass index, fat free mass and percentage body fat. These findings provide further evidence of age-related increases in erectile dysfunction, even when factors commonly associated with erectile dysfunction (eg, metabolic complications of obesity, use of medicines causing erectile dysfunction) are absent. The finding that number of wives is negatively related to erectile dysfunction may represent the specific cultural conditions (political power and wealth) associated with polygyny among the Ariaal.
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PMID:Erectile dysfunction and its correlates among the Ariaal of northern Kenya. 1601 78

Diagnosis of erectile dysfunction (ED) requires anamnestic investigation, being rarely spontaneously declared by patients. ED occurs frequently in diabetes mellitus, and anecdotal evidence suggests that ED occurs in obesity and in hypothyroidism. The aim of this study was to evaluate the prevalence of ED in patients affected by thyroid disorders (hypothyroidism and hyperthyroidism), in comparison with control subjects and with patients at risk for ED, such as patients with obesity and with type II diabetes mellitus, and the role of age. Spontaneous deposition and International Index of Erectile Dysfunction (IIEF)-5 questionnaire were considered for control subjects and for all patients. Spontaneous deposition of ED occurred for three diabetic patients, never for obese patients, thyroid patients and controls, confirming the value of IIEF-5 in detecting ED. ED was more frequent in obese subjects (42%), and in patients affected by thyroid diseases (59%), than in controls (30%), although less frequent than in type II diabetes mellitus (81%). Both below and above the age of 50 years, ED score was worse in thyroid patients than in control subjects, while ED was more frequent in obese patients than in control subjects only below the age of 50 years.
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PMID:Prevalence of erectile dysfunction in thyroid disorders: comparison with control subjects and with obese and diabetic patients. 1607 3

The metabolic syndrome, the criteria for which include glucose intolerance, obesity, hypertension, and dyslipidemia, has rapidly become understood to have a major association with erectile dysfunction (ED). On a mechanistic level, their common grounds may involve endothelial dysfunction, although the conditions of oxidative stress understood to be a pathologic element of the syndrome also may affect various components of the vascular biology of the penis. The foremost importance of recognizing the association between ED and the metabolic syndrome is that addressing ED presentations may afford opportunities to identify and improve a major adverse health profile and thereby promote health maintenance objectives for patients.
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PMID:Metabolic syndrome, endothelial dysfunction, and erectile dysfunction: association and management. 1623 22

Erectile dysfunction (ED) is a highly prevalent condition in aging men with significant interpersonal and psychosocial consequences. Large-scale epidemiologic studies have demonstrated a consistent age-related loss of erectile function in men from different geographic and ethnic backgrounds, with approximately half of men over 70 years of age reporting moderate to severe symptoms. ED is associated strongly with specific comor-bidities, such as cardiovascular disease and hypertension, diabetes mellitus, lower urinary tract symptoms, prostate cancer, and depression. Lifestyle factors, including obesity and exercise frequency, also have been implicated in recent studies.
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PMID:Epidemiology of erectile dysfunction: the role of medical comorbidities and lifestyle factors. 1629 Oct 33

We prospectively examined common coronary artery disease (CAD) risk factors (age, smoking, hypertension, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and obesity) in 570 community-dwelling men, aged 30 to 69 years (mean age, 46 years) at baseline. After an average follow-up period of 25 years, incident erectile dysfunction (ED) was evaluated by the 5-item International Index of Erectile Function. Age, body mass index, and hypercholesterolemia were each significantly associated with an increased risk of ED. In all, 1 in 5 men had > or =3 risk factors and were at a 2.2-fold increased risk of ED. Improving CAD risk factors in midlife may decrease ED risk as well as CAD risk.
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PMID:Heart disease risk factors predict erectile dysfunction 25 years later (the Rancho Bernardo Study). 1638 58

The past decade has witnessed a dramatic increase in the prevalence of obesity. Comorbidities of obesity include type 2 diabetes mellitus, hypertension, and lipid abnormalities, all of which contribute to cardiovascular disease (CVD) and are associated with endothelial dysfunction. These abnormalities frequently cluster in individuals, and the term metabolic syndrome is now widely used to define this cluster. The syndrome is frequently (although not invariably) associated with insulin resistance and CVD. Diabetes is associated with CVD, which may be asymptomatic in some cases, particularly when associated with autonomic neuropathy. This has implications for guidelines on the evaluation of patients with erectile dysfunction (ED) and CVD. Treatment of ED in men with diabetes has been revolutionized by the introduction of phosphodiesterase 5 inhibitors. However, men with diabetes tend to respond less positively to these agents, at least as currently prescribed. This decreased responsiveness may be related to the severity of endothelial function in patients with diabetes. Additional therapeutic strategies may be needed to overcome this problem.
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PMID:Endothelial and erectile dysfunction, diabetes mellitus, and the metabolic syndrome: common pathways and treatments? 1638 60

The prevalence of both cardiovascular disease (CVD) and erectile dysfunction (ED) increases with advancing age. These conditions share the common risk factors of diabetes mellitus, hypertension, hyperlipidemia, smoking, and obesity. They also share a pathophysiologic mechanism of decreased vascular blood flow via endothelial dysfunction. There are several lines of evidence that endothelial dysfunction in men with ED can be detected well before overt manifestations of vascular damage, including atherosclerotic effects. Some evidence shows that ED can be improved not only with phosphodiesterase 5 inhibitors but also by treating the risk factors directly. This includes cessation of smoking, correction of hyperlipidemia, and amelioration of obesity through weight loss. Conversely, ED may be prevented through maintenance of lean body mass, consistency of physical activity, and smoking abstinence, similar to other risk factors for CVD.
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PMID:Relation of endothelial cell function to erectile dysfunction: implications for treatment. 1638 68

A systematic literature search was conducted to investigate the cardiovascular issues related to hypogonadism and testosterone therapy. Vascular cells contain sex steroid hormone receptors. Testosterone can exert effects on the vascular wall, either by itself or through aromatization as estrogen. Hypogonadism is associated with central obesity; insulin resistance; low levels of high-density lipoprotein (HDL); high cholesterol levels; and high levels of low-density lipoprotein (LDL), triglycerides, fibrinogen, and plasminogen activator-1. Some observational studies show a correlation between low testosterone and cardiovascular disease (CVD), and others show no correlation. Interventional studies do not reveal a direct long-term relation between testosterone therapy and CVD. Short-term data suggest cardiovascular benefits of testosterone. Testosterone therapy has beneficial and deleterious effects on cardiovascular risk factors. It improves insulin sensitivity, central obesity, and lowers total cholesterol and LDL. In some studies, testosterone therapy has an HDL-lowering effect, and in other studies this effect is insignificant. This should not be assumed to be atherogenic because it might be related to reverse cholesterol transport and effects on the HDL(3) subfraction. The cardiovascular effects of testosterone therapy may be neutral to beneficial. There is no contraindication for testosterone therapy in men with CVD and diagnosed hypogonadism with or without erectile dysfunction. Caution should be exercised regarding occasional increases in hematocrit levels, especially in patients with congestive heart failure. Conversely, evidence does not support testosterone therapy in aging men for the purpose of cardiovascular benefit, despite claims to this effect. Further research on the cardiovascular benefits and risks of testosterone is strongly recommended.
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PMID:Cardiovascular issues in hypogonadism and testosterone therapy. 1638 71

Coronary artery disease (CAD) and erectile dysfunction (ED) are both highly prevalent conditions that frequently coexist. Additionally, they share mutual vascular risk factors, suggesting that they are both manifestations of systemic vascular disease. The role of endothelial dysfunction in CAD is well established. Normal erectile function is primarily a vascular event that relies heavily on endothelially derived, nitric oxide-induced vasodilation. Accordingly, endothelial dysfunction appears to be a common pathological etiology and mechanism of disease progression between CAD and ED. The risk factors of diabetes mellitus, hypertension, hyperlipidemia, obesity and tobacco abuse contribute to endothelial dysfunction. This article reviews the role of vascular endothelium in health, the abnormalities resulting from vascular risk factors, and clinical trials evaluating the role of endothelial dysfunction in ED.
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PMID:Linking erectile dysfunction and coronary artery disease. 1639 38


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