Sexual function in men older than 50 years of age: results from the health professionals follow-up study.

BACKGROUND: Although many studies have provided data on erectile dysfunction in specific settings, few studies have been large enough to precisely examine age-specific prevalence and correlates. OBJECTIVE: To describe the association between age and several aspects of sexual functioning in men older than 50 years of age. DESIGN: Cross-sectional analysis of data from a prospective cohort study. SETTING: U.S. health professionals. PARTICIPANTS: 31 742 men, age 53 to 90 years. MEASUREMENTS: Questionnaires mailed in 2000 asked about sexual function, physical activity, body weight, smoking, marital status, medical conditions, and medications. Previous biennial questionnaires since 1986 asked about date of birth, alcohol intake, and other health information. RESULTS: When men with prostate cancer were excluded, the age-standardized prevalence of erectile dysfunction in the previous 3 months was 33%. Many aspects of sexual function (including overall function, desire, orgasm, and overall ability) decreased sharply by decade after 50 years of age. Physical activity was associated with lower risk for erectile dysfunction (multivariable relative risk, 0.7 [95% CI, 0.6 to 0.7] for >32.6 metabolic equivalent hours of exercise per week vs. 0 to 2.7 metabolic equivalent hours of exercise per week), and obesity was associated with higher risk (relative risk, 1.3 [CI, 1.2 to 1.4] for body mass index >28.7 kg/m2 vs. <23.2 kg/m2). Smoking, alcohol consumption, and television viewing time were also associated with increased prevalence of erectile dysfunction. Men who had no chronic medical conditions and engaged in healthy behaviors had the lowest prevalence. CONCLUSIONS: Several modifiable health behaviors were associated with maintenance of good erectile function, even after comorbid conditions were considered. Lifestyle factors most strongly associated with erectile dysfunction were physical activity and leanness.

Association of type and duration of diabetes with erectile dysfunction in a large cohort of men.

OBJECTIVE: Differences in risk of erectile dysfunction (ED) by characteristics of diabetes among older men are not well understood. We examined the association of type and duration of diabetes with erectile function in men >50 years of age in a large prospective cohort study. RESEARCH DESIGN AND METHODS: Subjects included 31,027 men aged 53-90 years in the Health Professionals Follow-Up Study cohort. On a questionnaire mailed in 2000, participants rated their ability (without treatment) in the past 5 years to have and maintain an erection sufficient for intercourse. Men who reported poor or very poor function were considered to have ED. Diabetes information was ascertained via self-report and documented with supplementary medical data. RESULTS: Men with diabetes had an age-adjusted relative risk (RR) of 1.32 (95% CI 1.3-1.4) for having ED compared with men without diabetes. In multivariable regression analyses, men with type 1 and type 2 diabetes were at a significantly higher risk for ED (type 1 diabetes RR = 3.0, 95% CI 1.5-5.9; type 2 diabetes RR = 1.3, 1.1-1.5) than nondiabetic men. Men with type 2 diabetes had an increasingly greater risk of ED with increased duration since diagnosis (trend test P value <0.0001) (RR = 1.7, 95% CI 1.1-2.7, for men diagnosed >20 years previously). CONCLUSIONS: For men over age 50 years, increasing duration of diabetes was positively associated with increased risk of ED relative to nondiabetic subjects. This association persisted despite the higher prevalence of other comorbid conditions. ED prevention and diabetes management efforts are likely to go hand-in-hand.

A prospective study of risk factors for erectile dysfunction.

PURPOSE: We examined the impact of obesity, physical activity, alcohol use and smoking on the development of erectile dysfunction. MATERIALS AND METHODS: Subjects included 22,086 United States men 40 to 75 years old in the Health Professionals Followup Study cohort who were asked to rate their erectile function for multiple periods on a questionnaire mailed in 2000. Men who reported good or very good erectile function and no major chronic disease before 1986 were included in the analyses. RESULTS: Of men who were healthy and had good or very good erectile function before 1986, 17.7% reported incident erectile dysfunction during the 14-year followup. Obesity (multivariate relative risk 1.9, 95% CI 1.6-2.2 compared to men of ideal weight in 1986) and smoking (RR 1.5, 95% CI 1.3-1.7) in 1986 were associated with an increased risk of erectile dysfunction, while physical activity (RR 0.7, 95% CI 0.7-0.8 comparing highest to lowest quintile of physical activity) was associated with a decreased risk of erectile dysfunction. For men in whom prostate cancer developed during followup, smoking (RR 1.4, 95% CI 1.0-1.9) was the only lifestyle factor associated with erectile dysfunction. CONCLUSIONS: Reducing the risk of erectile dysfunction may be a useful and to this point unexploited motivation for men to engage in health promoting behaviors. We found that obesity and smoking were positively associated, and physical activity was inversely associated with the risk of erectile dysfunction developing.

Quality-of-life differences among various populations of localized prostate cancer patients: 2001.

An increasing number of studies are being published on the impact of localized prostate cancer on patient quality of life. Research suggests that the majority of patients diagnosed with prostate cancer return to pretreatment levels of general quality of life within 1 year after treatment. However, sexual, urinary, and bowel symptoms continue to be an issue for many patients beyond 1 year post-treatment. Focusing on psychologic impacts and social functioning, in addition to physical symptoms, may provide useful avenues for improving patient quality of life. We also discuss emerging evidence of racial and/or ethnic disparities in prostate cancer-related quality of life, the role of social networks and support in recovery and adjustment, as well as the impact of cancer recurrence.

The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients.

BACKGROUND: Most studies of treatment outcomes in men with localized prostate carcinoma have emphasized sexual, urinary, and bowel symptoms with the assumption that they have an impact on quality of life. However, very few studies have directly examined and compared the impact of these symptoms on overall and cancer specific quality of life. METHODS: The authors examined 783 incident cases of localized prostate carcinoma, diagnosed from 1993 to 1998, and 1928 age-matched healthy controls from the Health Professionals Follow-Up Study cohort. Information on frequency of ejaculation and urinary symptoms were collected before cancer diagnosis. After cancer diagnosis, the authors mailed a questionnaire including the Medical Outcomes Study Short Form-36 Health Status Survey (SF-36), the Cancer Rehabilitation Evaluation System-Short Form (CARES-SF), and the University of California at Los Angeles Prostate Cancer Index in 1998. RESULTS: Cases had slightly lower scores on most of the SF-36 scales and reported much more bother from sexual, urinary, and bowel symptoms compared with healthy controls. Among prostate carcinoma patients, bowel symptoms had the greatest negative impact on quality of life, followed by sexual and urinary symptoms. As expected, treatment-related symptoms were associated with the physical domains of quality of life, but psychosocial domains were just as strongly affected. CONCLUSIONS: Patients and health care providers need to consider the potential mental quality-of-life impacts associated with prostate carcinoma treatment symptoms when making treatment decisions. Even after patients have completed cancer treatment, significant health impairments may remain. Health care providers should continue to address the mental and physical well-being of prostate carcinoma patients in follow-up care.