Institute of Erectile Dysfunction Research - A Comprehensive Resource to Erectile Dysfunction and Impotence - News, Research, Causes, Treatment, Medications, Drugs

Arterioscler Thromb Vasc Biol. 2008 Jul;28(7):1207-8.
Comment on:

• Arterioscler Thromb Vasc Biol. 2008 Jul;28(7):1244-50.

Schleicher M, Sessa WC.

Aging Male. 2008 Jun;11(2):101-6.
Behre HM, Heinemann L, Morales A, Pexman-Fieth C.

Centre of Reproductive Medicine and Andrology, University Hospital Halle, Germany.

Hypogonadism is associated with a range of disease states that have significant effects on morbidity and mortality, and also affect quality of life. The ESPRIT study (Energy, Sexual desire and body PropoRtions wIth AndroGel, Testosterone 1% gel therapy) is a 6-month, multinational, open label, observational study in hypogonadal men being treated with transdermal AndroGel in usual daily clinical practice; 1,700-2,400 patients will be enrolled in Canada, Germany, Central and Eastern Europe, Russia and the Middle East. The main objective will be to evaluate the effect of AndroGel on symptoms of hypogonadism and quality of life as assessed by the Aging Males’ Symptoms scale. Further objectives include evaluating the effect and time to onset of improvement in erectile dysfunction and libido/sexual desire (International Index of Erectile Function), fatigue (Multi-dimensional Fatigue Index) and body composition (waist circumference, body mass index). Subgroup analyses will be performed: <50 years versus > or = 50 years; absence versus presence of metabolic syndrome. The safety of AndroGel will also be assessed. The study population will consist of newly diagnosed hypogonadal men (age > or = 18 years), in whom testosterone deficiency has been confirmed by clinical features and biochemical tests according to international guidelines, who are currently being prescribed AndroGel (testosterone 1% gel, starting dose 50 mg testosterone per day).

BJU Int. 2008 Jul;102(2):259; author reply 259-60.
Comment on:

• BJU Int. 2008 Mar;101(5):581-7.

Sed? J.

N Engl J Med. 2008 Jul 10;359(2):200-1; author reply 201-2.
Comment on:

• N Engl J Med. 2008 Mar 20;358(12):1250-61.

Arap W.

Ten years have passed since the introduction of phosphodiesterase (PDE-5) inhibitors (Viagra followed by Levitra and Cialis) for the treatment of erectile dysfunction. Recently, while watching a televised soccer game with my children, I saw one of the “anniversary commercials.” I, like most parents, exhaled when I did not get any questions about “what exactly is erectile dysfunction?”

However, I began to wonder if Madison Avenue has trivialized a serious medical discussion.

A number of cancer treatments create ED, whether through surgery, radiation therapy or even chemotherapy. One need look no further than management of prostate cancer, bladder and rectal carcinoma, and the management of certain testicular carcinomas to see the scope of the problem. It is estimated that men who undergo prostate treatment, even with newer techniques, have at least a 50 percent risk of impotence. A recent study from Canada, which reviewed a large number of patients treated for rectal cancer, found an astonishing 32 percent of males reported impotence with another 52 percent reporting partial impotence.

Erectile dysfunction is a serious complication from the treatment of these cancers. Once past the initial threat of their diagnosis, patients frequently report ED as one of the most frustrating side effects. Part of this appears to stem from inadequate discussion between patients and their doctors concerning the risks for ED and the likelihood of recovery. This frustration is also seen in the partners of these men, and this spans all age groups; contrary to advertising, intimacy is not confined to the young. Studies have indicated up to half of men aged 70 or older are sexually active.

PDE-5 inhibitors represent the first major step in drug therapy for erectile dysfunction. Nevertheless, these drugs have a number of side effects and may not work at all in a substantial number of patients. Research continues in an effort to define other pathways for drug therapy. And the advent of less invasive surgery and more precise radiotherapy may diminish the risk of ED resulting from these treatments.

So what have we learned in the last decade about erectile dysfunction despite all the marketing sensationalism? Clearly, it is a far more common problem than we knew and it has a significant impact upon men and their partners’ quality of life. Where I hope we are going is that patients and partners share with their treating physicians a free and open discussion about ED as a potential side effect. These discussions are normal, healthy and reasonable. Understanding the risks for ED and the treatments available are the keys to realistic expectations.

Jan Dombrowski, M.D., is medical director and radiation oncologist at Pluta Cancer Center.

Hey, ladies, take a beat before you start pilfering those little blue pills.

That’s the word from Dr. Ira D. Sharlip, a San Francisco urologist and president of the International Society for Sexual Medicine.

Although it may be tempting to act on news that the drug sildenafil, sold as Viagra, may ease the sexual side effects of antidepressant medications, swiping your husband’s stash or turning to Internet sources could be disappointing — or even dangerous.

“Any woman or man who is taking nitroglycerin drugs cannot take Viagra, Levitra or Cialis; it could be fatal,” Sharlip said, referring to other brand-name erectile dysfunction drugs. “I wouldn’t in any way advocate self-medicating with a drug like Viagra.”

New research showing that taking sildenafil significantly improved the ability to achieve orgasm in women suffering from sexual dysfunction caused by antidepressants could be important in a country where 180 million prescriptions for antidepressants are filled each year, mostly for women, and sexual dysfunction is reported in between 30 percent and 70 percent of patients.

However, Viagra didn’t do much for boosting women’s dampened desire, the study showed.

That’s no surprise, Sharlip said. Erectile dysfunction drugs work the same in women as they do in men: by increasing blood flow to the genitals and relaxing the walls of vessels. They don’t directly affect sexual desire. And sometimes, it’s hard to separate the two.

“The percent of women whose sexual dysfunction is due to specific blood flow is very low,” Sharlip said.

Viagra’s effect in women has been disappointing, but a new small study finds those on antidepressants may benefit from taking the little blue pills.  Viagra doesn’t only boost men’s performance in bed, but as it turns out, women too can reap benefits from the magical pill to fight sexual dysfunction. Sexual dysfunction is a common side effect of antidepressants and a major reason why people stop taking medication for their depression. This is particularly problematic given that twice as many women as men are prescribed antidepressants but the most effective drugs used to combat sexual dysfunction in men are not approved for use in women, the authors wrote.

Researchers from the University of New Mexico School of Medicine found that women who took the erectile dysfunction drug sildenafil, a.k.a Viagra, had an improvement in sexual function versus women who took a placebo.  The research involving 98 premenopausal women found Viagra helped with orgasm. But the benefits did not extend to other aspects of sex such as desire, researchers report in this week’s Journal of the American Medical Association.  The researchers said this is the first randomized controlled trial showing that there is a treatment for the sexual dysfunction women experience as a result of taking antidepressants.

“For women on antidepressants with orgasm problems, this may provide some wonderful relief,” said psychologist Stanley Althof, director of the Center for Marital and Sexual Health of South Florida in West Palm Beach, who was not involved in the study. “But it will not improve their desire or arousal.”

The new Viagra findings are based on an eight-week experiment. The 98 women were using antidepressants successfully but were having sexual problems. Their average age was 37.

The women agreed to attempt sexual activity at least once each week. Each time, they took a pill, not knowing whether it was Viagra or a matching dummy pill.

While 72 percent of the women taking Viagra reported improvement or stayed the same on an overall scale, only 27 percent of the women taking the placebo reported improvement or stayed the same.  Some of the women experienced headaches, flushing and indigestion but none of them withdrew from the trial because of side effects.

“These findings are important not only because women experience major depressive disorder at nearly double the rate of men and because they experience greater resulting sexual dysfunction than men, but also because it establishes that selective phosphodiesterase type 5 inhibitors [such as sildenafil] are effective in both sexes for this purpose,” the authors wrote in their study.

July 1, 2008 — Men hoping for some fireworks in their love life this Fourth of July may want to skip the burgers and beer at the barbecue and eat plenty of watermelon.  But according to recent studies, the juicy fruit may be better suited for Valentine’s Day. That’s because scientists say watermelon has ingredients that deliver Viagra-like effects to the body’s blood vessels and may even increase libido.  Watermelon may be a natural Viagra because the popular summer fruit is  in an amino acid called citrulline, which relaxes and dilates blood vessels much like Viagra and other drugs meant to treat erectile dysfunction (ED).

“We have known that watermelon has citrulline,” says Bhimu Patil, PHD, director of the Fruit and Vegetable Improvement Center at Texas A&M University, College Station.  How could watermelon be a natural Viagra? The amino acid citrulline is converted into the amino acid arginine, Patil says. “This is a precursor for nitric oxide, and the nitric oxide will help in blood vessel dilation.”

“The citrulline-arginine relationship helps heart health, the immune system and may prove to be very helpful for those who suffer from obesity and type 2 diabetes,” said Patil. “Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it.”

While there are many psychological and physiological problems that can cause impotence, extra nitric oxide could help those who need increased blood flow, which would also help treat angina, high blood pressure and other cardiovascular problems.

On hearing about the Texas finding, Irwin Goldstein, MD, editor-in-chief of The Journal of Sexual Medicine, was underwhelmed. Suggesting a man feast on watermelon to boost performance, he says, “would be the equivalent of someone dropping a beer bottle in Minneapolis, where the Mississippi River starts, and hoping to see it make an impact on someone in New Orleans.”

“To say that watermelon is Viagra-like is sort of fun,” says Goldstein. “But to even vaguely hope that eating watermelon will alleviate ED is misleading.”

“The vast majority of Americans produce enough arginine,” adds Goldstein, medical director of Alvarado Hospital Medical Center, San Diego, and clinical professor of surgery, University of California San Diego School of Medicine. “Men with ED are not deficient in arginine.”

Though arginine is required to make nitric oxide, and nitric oxide is required to dilate blood vessels and have an erection, “that doesn’t mean eating something that is rich in citrulline will make enough arginine that it will lead to better penile erections,” Goldstein says.

“Watermelon may not be as organ specific as Viagra,” Patil said, “but it’s a great way to relax blood vessels without any drug side-effects.”

The benefits of watermelon don’t end there, he said. Arginine also helps the urea cycle by removing ammonia and other toxic compounds from our bodies.

Citrulline, the precursor to arginine, is found in higher concentrations in the rind of watermelons than the flesh. As the rind is not commonly eaten, two of Patil’s fellow scientists, drs. Steve King and Hae Jeen Bang, are working to breed new varieties with higher concentrations in the flesh.

In addition to the research by Texas A&M, watermelon’s phyto-nutrients are being studied by the U.S. Department of Agriculture’s Agricultural Research Service in Lane, Oklahoma.

As an added bonus, these studies have also shown that deep red varieties of watermelon have displaced the tomato as the lycopene king, Patil said. Almost 92 percent of watermelon is water, but the remaining 8 percent is loaded with lycopene, an anti-oxidant that protects the human heart, prostate and skin health.

“Lycopene, which is also found in red grapefruit, was historically thought to exist only in tomatoes,” he said. “But now we know that it’s found in higher concentrations in red watermelon varieties.”

Lycopene, however, is fat-soluble, meaning that it needs certain fats in the blood for better absorption by the body, Patil said.

“Previous tests have shown that lycopene is much better absorbed from tomatoes when mixed in a salad with oily vegetables like avocado or spinach,” Patil said. “That would also apply to the lycopene from watermelon, but I realize mixing watermelon with spinach or avocadoes is a very hard sell.”

No studies have been conducted to determine the timing of the consumption of oily vegetables to improve lycopene absorption, he said.

“One final bit of advice for those Fourth of July watermelons you buy,” Patil said. “They store much better uncut if you leave them at room temperature. Lycopene levels can be maintained even as it sits on your kitchen floor. But once you cut it, refrigerate. And enjoy.”

Having regular sexual intercourse may help prevent the development of erectile dysfunction (ED) and impotence. New research published in the July 2008 issue of The American Journal of Medicine reports that scientists have found that men who had intercourse more often were less likely to develop erectile dysfunction and impotence.

The study was conducted over a course of five years with 989 Finish men aged 55 to 75 years. The assessment was based on the 5-item version of the validated International Index of Erectile Function. Men with erectile dysfunction at entry were excluded from the analysis. Researchers found that men who had intercourse less than once per week at baseline had twice the incidence of erectile dysfunction versus those who had intercourse at least once per week. The researchers concluded that the risk of impotence and ED was inversely related to the frequency of intercourse.

Mitigating factors such as age, chronic medical conditions (diabetes, heart disease, hypertension, cerebrovascular disease and depression), body mass index and smoking were included in the analysis of the data.

Men who had sexual intercourse less than once per week had an incidence of erectile dysfunction of 79 cases per 1000. Men who had intercourse once per week hand an incidence of 32 cases per 1000 and the rate dropped to 16 per 1000 for men who had sexual intercourse 3 or more times per week.

The researchers concluded that, “Regular intercourse protects against the development of erectile dysfunction among men aged 55 to 75 years. This may have an impact on general health and quality of life; therefore, doctors should support patients’ sexual activity.”

Reference: “Regular Intercourse Protects Against Erectile Dysfunction: Tampere Aging Male Urologic Study” by Juha Koskimäki, MD, PhD, Rahman Shiri, MD, PhD, Teuvo Tammela, MD, PhD, Jukka Häkkinen, MD, PhD, Matti Hakama, ScD, and Anssi Auvinen, MD, PhD. It appears in The American Journal of Medicine, Volume 121, Issue 7 (July 2008).

BJU Int. 2008 Jun;101(11):1336-8. Epub 2008 Apr 14.
Ritchie RW, Lindfield DM, Lockyer CR, Adamson A.

Department of Urology, Churchill Hospital, Oxford, UK. robritchie@doctors.org.uk18422763 [PubMed - indexed for MEDLINE]

J Urol. 2008 Jun;179(6):2317-20. Epub 2008 Apr 18.
Nehra A, Kumar R, Ramakumar S, Myers RP, Blute ML, McKusick MA.

Department of Urology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

PURPOSE: Potency preservation is one of the principal concerns surrounding newer developments in the management of organ confined carcinoma prostate. Nerve sparing techniques may not solely preserve erectile function and it is known that vascular factors may be an etiology of the dysfunction. The role of accessory pudendal arteries in the etiology and prevention of erectile dysfunction after radical prostatectomy is at present unclear. We reviewed pudendal angiograms in patients with erectile dysfunction to evaluate the prevalence and importance of these vessels. MATERIALS AND METHODS: Selective pudendal pharmacoangiograms were obtained in 79 consecutive patients with a history of erectile dysfunction. The aim was to identify accessory pudendal arteries, their origin and their significance relative to all identifiable pudendal arteries and the dorsal penile artery with respect to penile arterial inflow. RESULTS: An accessory pudendal artery was identified in 28 (35%) of the patients. The most common origin was the obturator artery. In 15 of the 28 men (54%) in whom an accessory artery was identified it appeared angiographically to be the dominant penile artery. In 3 patients it was apparently the only major arterial inflow to the penis. CONCLUSIONS: Accessory pudendal arteries may be identifiable with pharmacoangiograms in approximately a third of all men. Because they may be the dominant source of blood supply to the penis in some cases, their preservation during radical prostatectomy could be critical to erectile function following radical prostatectomy.18423744 [PubMed - indexed for MEDLINE]

J Urol. 2008 Jun;179(6):2321-6. Epub 2008 Apr 18.
Mondul AM, Rimm EB, Giovannucci E, Glasser DB, Platz EA.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

PURPOSE: Several studies have shown that men with lower urinary tract symptoms are more likely to experience erectile dysfunction. All except 1 of these studies were cross-sectional, limiting inferences about whether lower urinary tract symptoms precipitate erectile dysfunction. MATERIALS AND METHODS: The association between lower urinary tract symptoms and incident erectile dysfunction was examined prospectively in the Health Professionals Follow-Up Study. Lower urinary tract symptoms were assessed biennially by the American Urological Association symptom index, which captures symptoms of frequency, urgency and force of urinary stream. Severe lower urinary tract symptoms was defined as a symptom score of 20 points or greater and no lower urinary tract symptoms was defined as a score of 7 points or less in men not treated for lower urinary tract symptoms. In 2000 the men were asked to rate erectile function for several periods. Erectile dysfunction was defined as poor or very poor function, or erectile dysfunction medication use, while no erectile dysfunction was defined as very good or good function and no erectile dysfunction medication use. We estimated the RR using Poisson regression, adjusting for age and other potentially confounding factors. RESULTS: We observed 3,953 incident erectile dysfunction cases among 17,086 men. Men with severe lower urinary tract symptoms in 1994 or earlier had a statistically significant 40% higher risk of erectile dysfunction subsequently than men without lower urinary tract symptoms. The risk of erectile dysfunction increased with increasing lower urinary tract symptom severity (p trend <0.0001). The positive association between lower urinary tract symptoms and erectile dysfunction was stronger in younger than in older men (p interaction = 0.03). CONCLUSIONS: This study provides evidence that men with lower urinary tract symptoms are more likely to have erectile dysfunction subsequently.

Res Commun Mol Pathol Pharmacol. 2005;117-118:179-87.
Lee JH, Kim YC, Kwon JW, Kim WB, Lee MG.

College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, San 56-1, Shinlim-Dong, Kwanak-Gu, Seoul 151-742, South Korea.

Pharmacokinetic parameters of DA-8159 and one of its metabolites, DA-8164, were compared after intravenous and oral administration of DA-8159 at a dose of 30 mg/kg to control rats and rats pretreated with Klebsiella pneumoniae lipopolysaccharide (KPLPS). After intravenous and oral administration of DA-8159, most of the pharmacokinetic parameters of DA-8159 and DA-8164 were not significantly different between two groups of rats. This suggested that the pharmacokinetic parameters of DA-8159 and DA-8164 were not affected considerably by KPLPS.

J Sex Med. 2008 May;5(5):1062-5.
Michal V, Kramar R, Pospichal J, Hejhal L.

J Sex Med. 2008 May;5(5):1237-43.
Shabsigh R, Shah M, Sand M.

Division of Urology, Maimonides Medical Center, Brooklyn, New York, NY 07470, USA. rshabsigh@maimonidesmed.org

INTRODUCTION: The association between erectile dysfunction (ED) and cardiovascular risk factors is well established and ED can be considered an early marker for cardiovascular disease. Aim. To generate a calculator to predict the risk of diabetes, hypertension, hyperlipidemia or angina in men with ED, based on an analysis of data from the Men’s Attitudes to Life Events and Sexuality (MALES) 2004 study. MAIN OUTCOME MEASURE: A logistic regression model using the variables overall health, ED severity, having/not having a sexual partner, and waist size. METHODS: The MALES was a multinational, population-based study conducted in 2001, in which the prevalence of ED and comorbid medical conditions was assessed in 27,839 men aged 20-75 years. In 2004, the cohort of men with ED (N = 1843) were recontacted and 919 (50%) agreed to participate in the MALES 2004 longitudinal study. Multistep analysis of data from 808 patients was performed, with 289 variables evaluated. Only those variables significantly correlated with outcome and those making clinical sense were retained. A logistic regression model was applied to 90% of the sample; results were validated in the remaining 10% with sensitivity and specificity testing. RESULTS: Of the 2004 cohort, 20.7% had been diagnosed with diabetes, 44.3% with hypertension, 42.5% with hyperlipidemia, and 25.7% with angina. The following modifiable factors affected the risk of comorbidities, and were therefore included in the risk calculator: health status, waist size, ED severity, and having or not having a sexual partner. Using these variables in the model resulted in a sensitivity of 86.2% and specificity of 54.5%. The primary limitation of the calculator is that it is not a prediction calculator. CONCLUSION: Erectile dysfunction is a key factor in calculating the probability of major risks to men’s health, such as diabetes, hypertension, hyperlipidemia, and angina.18439154 [PubMed - indexed for MEDLINE]

Urology. 2008 May;71(5):897-900.
Al-Hunayan A, Thalib L, Kehinde EO, Asfar S.

Department of Surgery, Division of Urology, Kuwait University, Kuwait. alhunayan@hsc.edu.kw

OBJECTIVES: Hyperhomocysteinemia (HHcy) is associated with cardiovascular disease such as coronary arteriosclerosis and stroke. However, its role in the development of vasculogenic erectile dysfunction (ED) is still putative. In this study, we evaluated the relationship between plasma total homocysteine (tHcy) and the presence of vasculogenic ED in men with adult-onset diabetes mellitus. METHODS: This was a case-control study of 97 adult-onset diabetics with vasculogenic ED and 97 concurrently sampled control diabetics, who were free from ED. We obtained risk estimates of odds ratios (ORs), both crude and adjusted, using logistic regression models. We then determined cardiovascular risk factors and HbA1c levels in both groups of patients. RESULTS: Plasma tHcy was significantly higher in cases compared with controls. The mean +/- standard deviation plasma tHcy in cases was 11.2 +/- 3.5 micromol/L versus 8.8 +/- 2.6 micromol/L in controls (P <0.001). Moreover, those with HHcy had 5.2 times the odds of vasculogenic ED compared with men without HHcy (OR 5.2, 95% confidence interval, 1.4 to 18.9). Although the risk of ED did not vary significantly according to body mass index, serum cholesterol, triglycerides, C-reactive protein, and blood HbA1c levels, it was significantly affected by smoking status and hypertension. CONCLUSIONS: High plasma tHcy appears to be associated with ED in patient with adult-onset diabetes mellitus.18455630 [PubMed - indexed for MEDLINE]

Postgrad Med. 2008 Apr;120(1):54-63.
Miner M, Hellstrom WJ.

Department of Family Medicine, Warren Alpert School of Medicine, Brown University, and Men’s Health Center, Miriam Hospital, Providence, RI 02906, USA. martin_miner@brown.edu

Many men experience sexual function disorders, the most common of which are PE and ED. However, they may hesitate to seek treatment because of the perceived embarrassment associated with discussing their symptoms with a physician. The introduction of PDE-5 inhibitors for the treatment of ED has resulted in increased awareness of men’s sexual health; as a result, men may be more willing to discuss their symptoms of sexual dysfunction because they are aware that treatment options are available. An accurate diagnosis is important for effective treatment of sexual dysfunctions and depends on a detailed description of patient symptoms along with a complete sexual history. When forming a diagnosis, physicians must distinguish PE from ED and other sexual dysfunctions. To diagnose PE, a physician should incorporate measures that include personal distress and interpersonal difficulty between the patient and his partner. Premature ejaculation affects many men, and current pharmacologic treatment options are limited to off-label use of medications indicated for the treatment of depression or the distinct sexual dysfunction, ED. Therefore, the development of new pharmacologic treatments for PE is warranted.

Expert Opin Pharmacother. 2008 Jun;9(8):1421-9.
Costabile RA, Mammen T, Hwang K.

University of Virginia, Department of Urology, UVA Medical Center, Box 800422, Charlottesville, VA 22908, USA. rac2b@virginia.edu

BACKGROUND: Erectile dysfunction is a disease affecting millions of men over the age of 40. Alprostadil, a synthetic form of prostaglandin E(1), was introduced almost three decades ago, and is today considered an alternative treatment for erectile dysfunction. OBJECTIVE: The purpose of this article is to educate the reader on the mechanism of action of alprostadil and outline its indications, side effects, and compare it with other pharmacologic therapies for erectile dysfunction. Future horizons for its use are also discussed and an expert opinion on the use of alprostadil is offered. METHODS: The historical and recent literature was reviewed to provide a concise description. CONCLUSION: Alprostadil is safe and effective in the treatment of erectile dysfunction, mainly as second-line therapy for patients in which oral treatment is contraindicated or ineffective.

Health Qual Life Outcomes. 2008 May 12;6:33.
Revicki D, Howard K, Hanlon J, Mannix S, Greene A, Rothman M.

Center for Health Outcomes Research, United BioSource Corporation, Bethesda, Maryland, USA. dennis.revicki@united.biosource.com

BACKGROUND: Premature ejaculation (PE) is a common sexual dysfunction among men which affects men and their partners. Little qualitative data are available to characterize the impact of PE on men and their partners about ejaculatory control, sexual satisfaction, emotional distress and relationships. The objective of this study was to assess the impact of PE from the perspective of men with PE and the female partners of men with PE on their sexual experience, distress and relationships. METHODS: Qualitative data were collected through 14 focus groups in the US and through one-on-one interviews in the US, UK, Italy, France, Germany, and Poland. Study participants included heterosexual men with PE and female partners of males with PE. All participants were asked about how PE affects their daily life, including emotional impacts. One-on-one interviews also included obtaining feedback on the male and female versions of 4-single item measures of PE focusing on ejaculatory control, satisfaction with intercourse, interpersonal distress, and relationship difficulty. RESULTS: Participants included 172 males with PE and 67 female partners of men with PE. Lack of control over ejaculation and dissatisfaction with intercourse emerged as central themes of PE. Lack of ejaculatory control resulted in greater dissatisfaction and greater emotional distress, including feelings of inadequacy, disappointment, and anxiety. Continued PE ultimately leads to greater problems with partners and often disrupts partner relationships. Participants indicated that PE was keeping them from attaining complete intimacy in their relationships even when their partners were generally satisfied with sexual intercourse. Impacts of PE on sexual satisfaction, emotional distress and partner relationships were consistent across countries. Feedback on the single-item PE measures confirmed relevance of the item content and further confirmed major themes identified from the qualitative data. CONCLUSION: This qualitative study provides valuable insights on the substantial psychosocial burden of PE in the US and the Europe. Lack of control over ejaculation resulted in dissatisfaction with intercourse and increased emotional distress, and wide-ranging impact for both men with PE and their partners of men with PE. Data collected in this study may help inform the content of new patient reported measures for use in PE research.

Urol Nurs. 2008 Apr;28(2):101-5, 108.
Quallich SA, Ohl DA, Dunn RL.

Division of Andrology and Microsugery, Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA.

Erectile dysfunction continues to be a problem that can be successfully treated either through medical or surgical management. A cohort of self-identified experts in teaching the operation of penile implants completed a series of questions and tasks associated with three implant pump designs. This study examines the responses and impressions of these expert teachers in regard to three penile prosthesis pump designs. The goal of this project was to establish if one prosthesis pump was superior in the user’s ability to correctly identify components in a blinded, scrotal simulation study.