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International Journal of Impotence Research (1999) 11, Suppl 1, S65±S72 1 2

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International Journal of Impotence Research (1999) 11, Suppl 1, S65±S72 1 2 International Journal of Impotence Research (1999) 11, Suppl 1, S65±S72 1 2 DOES CHANGE IN CARDIOVASCLL\R RISK FACTORS SERUM ANDROGENS :\ND ERECTILE DYSFUNCTION: PREVENT ERECTILE DYSFUNCTIO'.\? Carol A. Derby, Beth LONGITUDINAL DATA I R0\1 THI \:IASSACHUSETTS A. Mohr, Irwin Goldstein, Henry A. Feldman, Catherine B. MALE AGING STUDY. lknrv A. Idd1nan*, Christopher Johannes, John B. McKinlay (New Engbnd Research Institutes, Longcopet, and John B. I\IcKinlay' 1*Ncw England Research Watertown, MA 02742, USA). Inst., Watertown MA; tliniv ..\1a,s. \frd. Ctr., Worcester MA). Erectile dysfunction (ED) increases in prevalence with age, Although modifiable risk factors for erectile dysfunction (ED) but its relation to the slow decline in serum testosterone or other have been identified, little is known regarding prevention. We hormones controlling sexual function is uncertain, despite prospectively examined the association of changes in smoking reports of amelioration hy supplemental testosterone. In the (yes/ no), heavy alcohol use (>3 drinks /day), sedentary lifestyle Massachusetts Male Aging Study, a large population-hascd (< 200 kcal/day of moderate to intense activity) and obesity (BMI random sample of men aged 40-70 were twice interviewed at 2 2: 30 kg/m ) to incident ED in the randomly selected cohort of the home, in 1987-89 and 1995-97, on each occasion providing Massachusetts Male Aging Study. Of 1709 men aged 40-70 in comprehensive health information. blood samples, and a 1987-1989, analyses included 593 with follow-up in 1995-1997 privately completed sexual ,1c1i,itv LJUcstionnaire. We analyzed who were free of ED at baseline, had no history of prostate a subsample of 634 men vv hu had minimal or no ED at baseline cancer, and were not treated for heart disease or diabetes. The and were free of diabetes. pms1at,' sur~rry. heart disease, or relation of risk status to incident ED (1\=102) was examined related medication. Horm<>nc· lcv ch were divided into low, using multiple logistic regression adjusted for age, hypertension, 111iddle, and high tertiles r, ,r an,dvsi, 1T 1. T2, T3). depression and testosterone. ED was defined by a private, self­ Incident ED (moderate ur C()mplctc I in the interval between administered questionnaire. For each nsk factor a 4-level baseline and followup was I (iA',r ov-er,tll. adjusted for age, and variable was created to represent men who stopped, acquired, or was significantly related to followup testosterone level (21.9% maintained the factor during follow-up, and were never exposed. in Tl, 14.9% in T2, 11.7% in T3) but not to baseline level. Changes in smoking and alcohol were not associated with ED. Incident ED was most frequent (24.4%) in men who showed a Baseline obesity predicted higher risk regardless of follow-up large decline in serum testosterone, from T3 at baseline to Tl at weight loss (p=0.007). Physical activity was associated with ED followup. and least frequent (6.8%) in those who showed a large (p=0.02), with risk highest among men who remained sedentary increase, from Tl to T3 (none receiving supplemental (probability, 95% CI 0.27, 0. 18-0.38), and lowest among those testosterone). Incident ED was frequent in men showing large who remained active or who initiated activity (probability, 95% changes in serum LH, those rising from Tl to T3 (30.2%) or CI 0.14, 0.l l-0.19 and 0.09, 0.04-0.16, respectively). Mid-life falling from T3 to TI (47. l '7, 1. Other honnones (DHEAS, DHT, changes may be too late to reverse the effects of smoking, obesity SHBG, FSH, estrone, cortisol. PR!,) .showed no relation to ED. and alcohol on ED. However, physical activity may reduce risk Our results suggest that al1hnu:;h ED 1, related to concurrent even if initiated in mid-life. Early adoption of healthy behaviors testosterone and LH level.s. hm1111 J11c il'vcls are not useful for may be optimal for prevention. predicting ED in middle-ag,·d men uvn an 8-10-year interval. 3 4 COMPARATIV~. ~:PIDEMIOLOGY OJ<' t:RECTILt: SEXUAL DYSFUNCTION IN WOMEN: OFFICE BASED SURVEY DYSFUNCTION '.ED) IN GAY MEN. Leslie Goldberg. OF WOMEN IN BOTH UROLOGIC AND GYNECOLOGIC Marc F. Stern, Da, id S. Posner, (MFS) Div. General Internal PRACTICES. Wellman W Cheung, Nabet G Kasabian, Stanton C Medicine, Albany Medical College, Albany, NY 12208 Honig, Mary J Minkin, Bruce R Gilbert, 900 Northern Blvd.,Suite Purpose: Discmsion of ED often explicitly or implicitly as­ 230, Great Neck, New York 11021 sumes that a patient's partner is a female. What little we know Introduction: The success of treating male sexual dysfunction has about ED in the setting of non-traditional relationships such as focused attention on women with similar concerns. However, little between gay men i, based on a few case series of gay men in data exists as to the magnitude of the problem or whether women therapy and yields no epidemiological data. This lack of would seek treatment if effective therapy was available. In this study knowledge and discussion may lead to barriers in diagnosis and we evaluate the prevalence of female sexual dysfunction in patients treatment. presenting for routine urologic or gynecologic care. We therefore undertook the first prospective, community-based Methods: 102 women anonymously completed a standardized study to determine the prevalence and etiology of ED in gay men questionnaire at the time of their scheduled visit to either a Methods: Presence and etiology of ED were determined using Gynecologic (N=76) or Urologic (N=26) office for reasons other the erectile function (modified) and 8-question discriminant then sexual dysfunction. function portions of the International Index of Erectile Function Results: The mean age of respondents was 42.9 ± 11.8 years with a (IIEF) and Florida Sexual History questionnaires, respectively range from 24.7 to 78.5 years old. 73% of respondents described Self-administered questionnaires were distributed in public venues their general medical health as excellent, with 6% reporting in San Francisco alld returned by mail to the investigators hypertension, I% smoke and none had diabetes. 39% of these Results Of I 93U questionnaires distributed, 735 (38°/4,) were women stated that their interest in sex has decreased with age. The returned After ex eluding bisexual and HIV+ men, there were major complaints were with an inability to have orgasm with 460 gay and 90 he,,:rosexual men ranging in age from 18 to 83. intercourse (28%) or other stimulation (26%), an inability to have ANCOVA analysis using age as a covariate showed no significant adequate vaginal lubrication (28%) and pain or spasm with relations difference in the prevalence of ED between homo- and heterosex­ (34%). Other complaints included lack of pleasure ( 15.8%), lack of ual males overall when controlling for age, although the increase genital sensation (9.8%) and inadequate sexual excitement (12.2%). in ED with age is more rapid in gay men. Among men with any Overall 81 % of respondents reported some degree of impairment of ED the prevalence of organic (vs psychogenic) ED was 44% in their sexual function while 55% indicated they would seek treatment gay men vs. 27% in heterosexual men; this was not a significant if effective therapy was available. difference (x'=l .6, ::,=0.2). With regard to a question on sexual Conclusions: This survey demonstrates a very high prevalence of practices, many gay men indicated that they did not always female sexual dysfunction in women seen in routine consultation by engage in penetrati ce sn both Urologists and Gynecologists. In addition, there is great interest Conclusions: Using available reliable and valid instruments, we could not find a difrerence in the prevalence or etiology of ED among women for safe and effective treatment options. Physicians between homo-and heterosexual men. Thus questions about ED with training and experience in dealing with male sexual dysfunction may be an important part of a complete history among both sets are uniquely positioned to effectively evaluate and treat women with of men. However, more research is required to determine if sexual disorders and should consider becoming involved in the instruments design,;d for heterosexual men adequately measure treatment options currently available as well as those under this phenomenon i,1 gay men. investigation. Podium presentations S66 5 6 FEMALE SEXUAL DYSFUNCTION: PREVALENCE INJECTION OF GLUTAMATE SUBTYPE AND PHYSIOLOGIC CORRELATES Lawrence S. Hakim, AGONISTS IN THE PARAVENTRICULAR Rebecca Wein-Szomstein, Deena Evans, Miami, FL and Ajay NUCLEUS OF THE HYPOTHALAMUS OF MALE Nehra, Rochester, MN. (Presented by Dr. Nehra) RATS CAUSES ERECTIONS. Abdel R. Zaharan, Pascal Vachon & Serge Carrier. PURPOSE: To study the epidemiology, prevalence and Urology Research Laboratory, Lady Davis Institute, physiologic correlates of sexual dysfunction in the partners of Montreal. men undergoing office urologic evaluation for ED. METHODS: 150 women anonymously and voluntarily Objectives: The objective of the present study is to completed a 2-page questionnaire including: demographic data, evaluate the effect of different excitatory aminoacids medical and sexual history, and questions regarding sexual (NMDA, AMPA & ACPD) on ICP when injected in the arousal and excitement. Six questions specifically addressing PVN. various vaginal and clitoral complaints, such as lubrication, Methods: 30 Sprague-Dawely rats were anesthetised engorgement, sensation and orgasm were included. and placed in a stereotaxic apparatus after catheterization RESULTS: 84/150 (56%) women (ages: 25-82; mean: 54), of the carotid artery and CC for pressure monitoring. The were diagnosed with FSD, with various vaginal and clitoral rats were subdivided into three groups (n=lO). 5 animals complaints consistent during the course of the sexual relationship, causing personal distress. Severe FSD (3 or more from each group were injected with glutamate subtype sexual complaints) was more likely to be seen in women who agonists in the PVN using a 0.5 µI Hamilton syringe(dose were: 1) older (often menopausal), 2) cigarette smokers, 3) of 60 ng/µl, vol.
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