A population-based survey of lower urinary tract symptoms (LUTS) and symptom-specific bother: results from the Brazilian LUTS epidemiology study (BLUES).

PURPOSE: To examine the prevalence of lower urinary tract symptoms (LUTS) and the bother they impose in a population-based sample of adults in Brazil. METHODS: A cross-sectional population-based survey was conducted between September 2006 and January 2007 in the city of Salvador, Brazil. Cluster samples of representative households were randomly selected for interviews. A structured questionnaire was administered to men and women aged 30 years or older by trained interviewers. Participants were asked about the presence of individual LUTS using current International Continence Society (ICS) definitions and rated their symptom bother. Those with overactive bladder (OAB) also responded the OAB-Validated 8 and the Patient Perception of Bladder Condition questionnaires. RESULTS: Of 3,616 eligible subjects, 3,000 (83%) participated (1,500 men and 1,500 women). OAB was present in 5.1% of men and in 10% of the women, while the prevalence of any LUTS was 81.5 and 84.1%, respectively. The majority of subjects with OAB, 80% of men and 78% of women, reported some bother associated with their urgency symptoms. Overall, storage symptoms were more common than voiding or postmicturition symptoms. Women reported storage symptoms (76.4%) more frequently than men (67.7%), while the opposite was true for voiding (men 39.7%, women 33.7%) and postmicturition (men 30.9%, women 12.8%). CONCLUSIONS: This is the largest population-based survey of LUTS in Brazil, using the 2002 ICS definitions. LUTS prevalence was high and increased with age among both genders in Brazil, whereas the rates of OAB were somewhat lower than previously reported. The high prevalence of urinary symptoms and the bother commonly associated with them highlight their importance to overall well-being.

Lower urinary tract symptoms are associated with depressive symptoms in white, black and Hispanic men in the United States.

PURPOSE: The relationship between lower urinary tract symptoms and depressive symptoms was assessed using data from the Male Attitudes Regarding Sexual Health study. MATERIALS AND METHODS: Lower urinary tract symptoms, depressive symptoms and erectile dysfunction were assessed using International Prostate Symptom Score, Center for Epidemiologic Studies Depression Scale and a validated question from the Massachusetts Male Aging Study. Sociodemographic, clinical and other data were also collected. Odds ratios and 95% CIs were determined using weighted multivariate logistic regression stratified by race/ethnicity and age. RESULTS: Of 3,291 randomly selected men 2,173 completed the interview. Overall odds of lower urinary tract symptoms were increased in men who reported depressive symptoms (OR 2.68, 95% CI 1.60-4.47, p <0.01), erectile dysfunction (OR 1.73, 95% CI 1.11-2.71, p <0.05) and unhappiness/dissatisfaction on the International Prostate Symptom Score quality of life item (OR 10.72, 95% CI 5.56-20.69, p <0.01), and those 60 to 69 years old (OR 1.99, 95% CI 1.14-3.46, p <0.05) and 70 years or older (OR 1.91, 95% CI 1.06-3.43, p <0.05). Increased odds of lower urinary tract symptoms were associated with depressive symptoms for white (OR 2.60, 95% CI 1.39-4.85, p <0.01) and Hispanic men (OR 4.14, 95% CI 1.15-14.95, p <0.05). Odds of depressive symptoms were increased in men reporting lower urinary tract symptoms (OR 2.64, 95% CI 1.57-4.43, p <0.001), especially Hispanic men 50 to 59 years old (OR 133.17, 95% CI 18.40-963.87, p <0.01) and black men older than 60 years (OR 21.61, 95% CI 3.04-153.55, p <0.01), as well as men 40 to 49 years old expressing unhappiness/dissatisfaction on the International Prostate Symptom Score quality of life item (OR 6.80, 95% CI 1.77-26.16, p <0.01), and Hispanic (OR 10.76, 95% CI 3.88-29.80, p <0.01) and black men reporting erectile dysfunction (OR 4.77, 95% CI 1.15-19.78, p <0.05), but not white men reporting erectile dysfunction (OR 1.05, 95% CI 0.48-2.28, p <0.91). CONCLUSIONS: Lower urinary tract symptoms and depressive symptoms are strongly associated, and exhibit reciprocal relationships. Erectile dysfunction increases the odds of both disorders.

A prospective study of lower urinary tract symptoms and erectile dysfunction.

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.

Sexual problems and help-seeking behaviour in adults in the United Kingdom and continental Europe.

OBJECTIVES: To study sexual activity, the prevalence of sexual dysfunction, and related help-seeking behaviour patterns among middle-aged and older people in the UK and Europe. SUBJECTS AND METHODS: A telephone survey was conducted using a structured questionnaire covering demographics, health, relationships, and sexual behaviour, attitudes and beliefs. In the UK, 1500 individuals completed the survey. RESULTS: Overall, 69% of men and 56% of women reported having sexual intercourse during the past year. The most common male sexual problems, i.e. early ejaculation (20%) and erectile dysfunction (18%), were more common in the UK than in other European regions. The most common female sexual problems, i.e. a lack of sexual interest (34%) and a lack of pleasure in sex (25%), were also more common in the UK than in other European regions. Only 26% of men and 17% of women had discussed their sexual problem(s) with a doctor. CONCLUSION: Many people in the UK maintain sexual interest and activity into middle age and beyond. Although they experience sexual problems, few seek medical help. This might be because they do not perceive such problems as serious or sufficiently upsetting, and/or are not aware of available treatments.

Erectile function and risk of Parkinson's disease.

Erectile dysfunction is common among individuals with Parkinson's disease, but it is unknown whether it precedes the onset of the classic features of Parkinson's disease. To address this question, the authors examined whether erectile dysfunction was associated with Parkinson's disease risk in the Health Professionals Follow-up Study. Analyses included 32,616 men free of Parkinson's disease at baseline in 1986 who in 2000 completed a retrospective questionnaire with questions on erectile dysfunction in different time periods. Relative risks were computed using Cox proportional hazards models adjusting for age, smoking, caffeine intake, history of diabetes, and other covariates. Among men who reported their erectile function before 1986, 200 were diagnosed with Parkinson's disease during 1986-2002. Men with erectile dysfunction before 1986 were 3.8 times more likely to develop Parkinson's disease during the follow-up than were those with very good erectile function (relative risk = 3.8, 95% confidence interval: 2.4, 6.0; p < 0.0001). Multivariate-adjusted relative risks of Parkinson's disease were 2.7, 3.7, and 4.0 (95% confidence interval: 1.4, 11.1; p = 0.008) for participants with first onset of erectile dysfunction (before 1986) at 60 or more, 50-59, and less than 50 years of age, respectively, relative to those without erectile dysfunction. In conclusion, in this retrospective analysis in a large cohort of men, the authors observed that erectile dysfunction was associated with a higher risk of developing Parkinson's disease.

Sexual disorders and associated help-seeking behaviors in Canada.

OBJECTIVES: To study sexual activity, the prevalence of sexual difficulties and related help-seeking behaviors, among mature adults in Canada. MATERIALS AND METHODS: A telephone survey (random digit dialed) was conducted in Canada in 2001 to 2002. Interviews were based on a standardized questionnaire, including demographics, general health, relationships, and sexual behaviors, attitudes and beliefs. The survey was completed by a total of 1007 individuals (500 men and 507 women) aged 40 to 80 years in Canada. RESULTS: Overall, 83% of men and 71% of women had engaged in sexual intercourse during the 12 months preceding the interview, and 42% of men and 36% of women engaged in sexual intercourse more than once a week. Early ejaculation (23%) and erectile difficulties (16%) were the sexual problems most frequently reported by men. The sexual problems most frequently reported by women were a lack of sexual interest (30%) and lubrication difficulties (24%). Older age (60 to 80 years compared with 40 to 49 years) and diagnoses of depression and diabetes were all significant predictors of erectile difficulties in men. More than 75% of men and women had sought no help for their sexual problem(s) from a health professional. CONCLUSIONS: Many middle aged and older adults in Canada report continued sexual interest and activity. Although a number of sexual problems are highly prevalent in this population, few individuals seek medical help for these problems. This may be partly because they are not sufficiently bothered by the problem or do not think that it is serious.

Evaluation of acute risk for myocardial infarction in men treated with sildenafil citrate.

Sexual intercourse is a rare trigger of acute myocardial infarction (MI). In the 2 hours after intercourse, the risk for MI is increased twofold to fourfold. However, there is limited information on the risk for MI after intercourse in men receiving treatment for erectile dysfunction. This study aimed to evaluate whether the use of sildenafil citrate in men with erectile dysfunction is associated with the triggering of acute MI. A self-matched case-crossover approach was used to evaluate the incidence of MI in men enrolled in 80 clinical trials of sildenafil at sites worldwide from 1993 to 2000. The risk for MI was assessed during 2 hazard periods: within 24 and within 6 hours after the ingestion of sildenafil. Relative risk was estimated using the Mantel-Haenszel estimator for sparse person-time data. A total of 69 MIs were observed during >11,000 person-years of exposure to sildenafil. The mean time between the last dose of sildenafil and the onset of MI was 14 +/- 2.9 days. The relative risk for MI was 0.80 (95% confidence interval [CI] 0.52 to 1.26) within 24 hours after taking sildenafil and 0.79 (95% CI 0.33 to 1.87) within 6 hours after taking sildenafil. In conclusion, these data indicate that sildenafil was not associated with short-term risk for MI and are consistent with the growing body of evidence that sildenafil use is not associated with an increased risk for cardiovascular events.

Efficacy and safety of sildenafil citrate in men with erectile dysfunction and chronic heart failure.

Chronic heart failure (CHF) is an increasingly common cardiovascular disorder. Many patients who have CHF report moderate to marked decreases in the frequency of sexual activity, and up to 75% of patients report erectile dysfunction (ED). There are few controlled clinical data on the efficacy and safety of sildenafil citrate in men who have ED and CHF; thus, we evaluated these parameters in patients who had stable CHF. This was a double-blind, placebo-controlled, flexible-dose study. Men who had ED and stable CHF were randomized to receive sildenafil or placebo for 12 weeks. Primary outcomes were questions 3 and 4 of the International Index of Erectile Function. Secondary outcomes included the 5 functional domains of the International Index of Erectile Function, 2 global efficacy assessment questions, intercourse success rate, the Erectile Dysfunction Inventory of Treatment Satisfaction, and the Life Satisfaction Checklist. By week 12, patients who received sildenafil (n = 60) showed significant improvements on questions 3 and 4 compared with patients who received placebo (n = 72; p <0.002). Larger percentages of patients who received sildenafil reported improved erections (74%) and improved intercourse (68%) compared with patients who received placebo (18% and 16%, respectively). Intercourse success rates were 53% among patients who received sildenafil and 20% among those who received placebo. Patients who received sildenafil were highly satisfied with treatment and their sexual life compared with patients who received placebo. Sixty percent of patients who received sildenafil and 48% of patients who received placebo developed adverse events, including transient headache, facial flushing, respiratory tract infection, and asthenia. The incidence of events related to cardiovascular effects was low. Sildenafil is an effective and well-tolerated management of ED in men who have mild to moderate CHF.

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.

Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease.

This was a double-blind, placebo-controlled, flexible-dose study of the efficacy and safety of sildenafil in men with erectile dysfunction (ED) and clinically stable coronary artery disease (CAD). Patients were randomized to receive sildenafil or placebo for 12 weeks. Primary outcomes were questions 3 and 4 of the International Index of Erectile Function (IIEF). Secondary outcomes included the other IIEF questions and functional domains, the Life Satisfaction Checklist, the Erectile Dysfunction Inventory of Treatment Satisfaction, 2 global efficacy assessment questions, and intercourse success rate. By week 12, sildenafil-treated patients (n = 70) showed significant improvements on questions 3 and 4 compared with placebo-treated patients (n = 72; p <0.01). Larger percentages of sildenafil-treated patients reported improved erections (64%) and improved intercourse (65%) compared with placebo-treated patients (21% and 19%, respectively). Sildenafil-treated patients were highly satisfied with treatment and their sexual life compared with placebo-treated patients. Forty-seven percent of sildenafil- and 32% of placebo-treated patients experienced adverse events, including transient headache, hypertension, flushing, and dyspepsia. There were no serious drug-related cardiovascular effects. Thus, sildenafil is an effective and well-tolerated treatment for ED in men with CAD. Sildenafil was not associated with additional safety risks in this patient population.

Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada.

BACKGROUND: Studies have shown that patients with schizophrenia have higher rates of cardiovascular disease and mortality compared with the general population. However, population-based data on the prevalence, incidence, and mortality of cardiovascular disease are needed. METHOD: In this retrospective cohort study, the Saskatchewan Health databases were searched for all patients diagnosed with schizophrenia (ICD-9 code 295) in 1994 or 1995. 3022 subjects were identified. For each subject, 4 age- and sex-matched comparison individuals were selected randomly among residents of the province who had no diagnosis of schizophrenia or any other mental disorders and who received no prescriptions for antipsychotic medications. Prevalence of cardiovascular morbidity during 1994 and 1995 and incidence of cardiovascular morbidity and mortality during the follow-up period of January 1996 through March 1999 were analyzed. RESULTS: Concerning prevalence of morbidity in schizophrenia patients, significantly increased risk-adjusted odds ratios were as follows: arrhythmia, 1.5 (95% CI = 1.2 to 1.8); syncope, 4.0 (95% CI = 2.0 to 7.9); heart failure, 1.7 (95% CI = 1.4 to 2.2); stroke, 2.1 (95% CI = 1.6 to 2.7); transient cerebral ischemia, 2.6 (95% CI = 1.7 to 3.7); and diabetes, 2.1 (95% CI = 1.8 to 2.4). Odds of acute myocardial infarction, ischemic heart disease, and ventricular arrhythmias were not significantly different from those for the comparison group. Concerning incidence of morbidity and mortality in the patients, adjusted relative risk was significantly increased for ventricular arrhythmia, 2.3 (95% CI = 1.2 to 4.3); heart failure, 1.6 (95% CI = 1.2 to 2.0); stroke, 1.5 (95% CI = 1.2 to 2.0); diabetes, 1.8 (95% CI = 1.2 to 2.6); all-cause mortality, 2.8 (95% CI = 2.3 to 3.4); and cardiovascular mortality, 2.2 (95% CI = 1.7 to 2.8). CONCLUSIONS: Persons with schizophrenia appear to be at greater risk for cardiovascular morbidity and mortality than those in the general population.

Sildenafil citrate for erectile dysfunction in men receiving multiple antihypertensive agents: a randomized controlled trial.

BACKGROUND: Erectile dysfunction (ED) is common among men taking antihypertensive drugs to control blood pressure. We evaluated the safety and efficacy of sildenafil citrate for treating ED in men taking multiple antihypertensive medications in a randomized, double-blind, placebo-controlled trial. METHODS: A total of 568 men (> or =18 years) with ED and hypertension who were taking two or more antihypertensives were randomized to sildenafil (n = 281) or matching placebo (n = 287) for a 6-week double-blind trial followed by a 6-week open-label phase during which all patients received sildenafil. Primary efficacy variables were questions (Q) 3 and 4 (frequency of erections and penetration) of the International Index of Erectile Function (IIEF), and secondary efficacy variables were two global efficacy assessment (GEA) questions regarding improvement in erections and intercourse. RESULTS: A total of 562 men (mean age, 59 years) took > or =1 dose of study drug. At week 6, mean scores on both Q3 and Q4 improved significantly among sildenafil-treated compared with placebo-treated patients. In regard to Q3 and Q4 there were no differences between patients taking two and those taking three or more antihypertensive agents. In all, 71% and 69% of sildenafil-treated patients reported improved erections (GEA1) and intercourse (GEA2) compared with 18% and 20% of placebo-treated patients, respectively. By week 12, >80% of all patients (regardless of initial treatment group) had improved erections and intercourse. During double-blind treatment, 40% of sildenafil-treated and 25% of placebo-treated patients experienced adverse events; fewer than 2% in each group discontinued because of adverse events. CONCLUSIONS: Sildenafil was an effective and well tolerated treatment for ED in men receiving multiple antihypertensives. The results suggest that there were no additional safety risks associated with the use of sildenafil in these patients.

A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men.

BACKGROUND: Depression and erectile dysfunction (ED) have a complex and bi-directional relationship. We examined the relationships between erectile dysfunction and depressive symptoms or diagnosed depression, sexual activity and sexual satisfaction. METHODS: A population survey of men aged 40-70 years was carried out in Brazil, Italy, Japan and Malaysia in 1997-1998. A questionnaire was used to collect life style, sexual behaviors and medical data. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. ED was classified as moderate or complete if the men reported they were "sometimes" or "never" able to achieve and maintain an erection satisfactory for sexual intercourse. Only men with a sexual partner and not taking psychoactive drugs were considered. RESULTS: Diagnosed depression was reported by 2.0% of the men, depressive symptoms by 21.0%. The prevalence of moderate or complete ED was 17.8%. Sexual satisfaction related to the frequency of sexual intercourse and inversely related to depressive symptoms. Depressive symptoms were positively associated with being single (odds ratio [OR] 1.7), widowed, separated or divorced (OR 2.2), moderate or complete ED (1.8), heart disease (1.6) and smoking (1.6), and negatively associated with age, physical activity and frequency of sexual intercourse. LIMITATIONS: Cross-sectional studies cannot establish a temporal cause-effect relationship. However, the confirmation of known associations reassures about the validity of the original findings. CONCLUSIONS: The findings suggest that depressive symptoms are linked to ED by the mediation of decreased sexual activity and the dissatisfaction generated by the inability to have a healthy sexual life.

Sexual difficulties and help-seeking among mature adults in Australia: results from the Global Study of Sexual Attitudes and Behaviours.

BACKGROUND: The Global Study of Sexual Attitudes and Behaviours was a survey of 27 500 men and women in 29 countries. Here we report the sexual activity, the prevalence of sexual difficulties and related help-seeking behaviour among participants in Australia. METHODS: A telephone survey was conducted in Australia in 2001-2002, with interviews based on a standardised questionnaire. A total of 1500 individuals (750 men and 750 women) aged 40 to 80 years completed the survey. The questionnaire covered demographic information, overall health, and sexual behaviours, attitudes and beliefs. RESULTS: Overall, 83% of men and 74% of women had engaged in sexual intercourse during the 12 months preceding the interview, and 38% of all men and 29% of all women engaged in sexual intercourse more than once a week. Early ejaculation (23%), erectile difficulties (21%) and a lack of sexual interest (18%) were the most common male sexual difficulties. The most frequently reported female sexual difficulties were: lack of sexual interest (33%), lubrication difficulties (26%) and an inability to reach orgasm (25%). Older age was a significant predictor of male erectile difficulties and of lubrication difficulties in women. Only a minority of men and women had sought help for their sexual difficulty(ies) from a health professional. CONCLUSIONS: Many middle-aged and older adults in Australia report continued sexual interest and sexual activity. Several sexual difficulties are highly prevalent in this population, but those experiencing these difficulties rarely seek medical help. This may be because they do not perceive such difficulties as serious or sufficiently upsetting.

Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviors.

To study the sexual activity and the prevalence of sexual dysfunctions and related help seeking behaviour, among people in Europe aged 40-80 years. A telephone survey was carried out in 2001-2002 in Sweden, the UK, Belgium, Germany, Austria, France, Spain and Italy, of 4,977 men and 5,023 women, using a structured, standardized questionnaire Eighty-three percent of men and 66% of women had sexual intercourse during the year preceding the interview. The sexual dysfunctions most frequently reported were early ejaculation (11%) and erectile dysfunction (8%) in men; and a lack of sexual interest (18%), an inability to reach orgasm (13%) and lubrication difficulties (11%) in women. Of the 23% of men and 32% of women who reported sexual dysfunction, 26% had consulted a physician, with considerable between-country differences. Sexual activity is widespread among adult middle-aged and elderly people, but many experience sexual dysfunctions and few seek medical care.

Sexual activity, sexual disorders and associated help-seeking behavior among mature adults in five Anglophone countries from the Global Survey of Sexual Attitudes and Behaviors (GSSAB).

We conducted a telephone survey during 2001-2002 to investigate sexual behavior, sexual dysfunction, and related help-seeking behavior in five Anglophone countries. In total, 5,998 individuals (2,992 men and 3,006 women) aged 40-80 years in the United States, Canada, the United Kingdom, Australia, and New Zealand completed the survey. The majority of subjects were sexually active, and although many men and women had experienced sexual dysfunctions, few had sought medical care for these dysfunctions. Further investigation is required to determine whether national differences in the prevalence of sexual dysfunctions are due to genetic predisposition, health factors, cultural perception or socioeconomic situation.

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.

A cross-national study of subjective sexual well-being among older women and men: findings from the Global Study of Sexual Attitudes and Behaviors.

Subjective sexual well-being refers to the cognitive and emotional evaluation of an individual's sexuality. This study examined subjective sexual well-being, explored its various aspects, examined predictors across different cultures, and investigated its possible associations with overall happiness and selected correlates, including sexual dysfunction. Data were drawn from the Global Study of Sexual Attitudes and Behaviors, a survey of 27,500 men and women aged 40-80 years in 29 countries. The cross-national variation of four aspects of sexual well-being (the emotional and physical satisfaction of sexual relationships, satisfaction with sexual health or function, and the importance of sex in one's life) was explored using cluster analysis, and relationships among sexual well-being, general happiness, and various correlates were examined using ordinary least squares regression and ordered logistic regression. Results from the cluster analysis identified three clusters: a gender-equal regime and two male-centered regimes. Despite this cultural variation, the predictors of subjective sexual well-being were found to be largely consistent across world regions.

Sexual activity, sexual dysfunction and associated help-seeking behaviours in middle-aged and older adults in Spain: a population survey.

To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviours among mature adults in Spain, a telephone survey was conducted in Spain in 2001-2002. This was completed by 750 men and 750 women aged 40-80 years. Eighty-eight percent of men and 66% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (31%) and lack of sexual interest (17%) were the most common male sexual problems. A lack of sexual interest (36%) and an inability to reach orgasm (28%) were the most common female sexual problems. Approximately 80% of men and women with a sexual problem had not sought help from a health professional. Many men and women in Spain report continued sexual interest and activity into middle age and beyond. Although a number of sexual problems are highly prevalent, few people seek medical help.