Is milder psychological stress responsible for more severe erectile dysfunction?

China is a sexually conservative country compared with Western countries. To evaluate the psychological characteristics of Chinese erectile dysfunction (ED) patients, we conducted a cross-sectional study of 153 ED outpatients. Patients were interviewed with the Structured Interview on Erectile Dysfunction (SIEDY) for pathogenic quantification. ED was measured by International Index of Erectile Function (IIEF). Depression and anxiety were evaluated with 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalised Anxiety Disorder Scale (GAD-7) respectively. Most patients (74.5%) were <40 years old. IIEF-5 were significantly correlated with SIEDY scale 3 (r = .16, p = .040) and GAD-7 (p = .15, p = .033). The SIEDY scale 1 increased with age, but the IIEF-5, SIEDY scale 3, PHQ-9 and GAD-7 decreased with age. A negative correlation was observed between ED and psychological stress, which conflicts with many Western-country studies. Younger patients were characterised by milder ED but more psychological stress, while older patients were characterised by worse ED but less psychological stress. Which may be responsible for the conflicting result. Meanwhile, the much younger age distribution among Chinese ED outpatients may indicate that quite a few older ED patients (≥40 years) in China do not seek outpatient service which should merit more attention.

When he is "tied": power, vulnerability, and embodied masculinity in Egypt.

This paper looks at the notion of rabt [tying], the inability of the groom to engage in penetrative intercourse on the wedding night, to explore the relationship between masculinity, embodiment, and sexual performance. Drawing on ethnographic fieldwork in Egypt between 1993 and 2015, this paper explores the notion of groom rabt, how it is socially defined and managed. After presenting my conceptual framework for the study of sexuality and embodiment, the paper moves to discuss the meaning of the wedding night; the social clues people draw on when they identify rabt; how these clues relate different events to the (in)abilities of the groom; and how women, particularly mothers, work to protect and heal their male relatives from this affliction. To understand moments when individuals are unable, or "fail," to produce desirable physical and social effects, it is important that we do not exclusively consider the individual sexed body - the body that is clearly defined, bounded, and invested with unique desires and feelings. We must also consider the broader configurations that connect different bodies, endow them with certain meanings, and produce their materiality. My discussion shows that our understanding of sexuality and reproductive health will continue to be limited if we consider only men or women as separate individuals or as autonomous couples. Exploring moments of biological-social vulnerability, such as rabt, and how they relate to broader projects of gendering helps us understand issues linked to reproductive health and sexual rights in a deeper sense.

Ethnicity and age as factors in sildenafil treatment of erectile dysfunction.

INTRODUCTION: Sildenafil has been evaluated in >16 000 men with erectile dysfunction (ED) in double-blind, placebo-controlled trials. AIM: To assess efficacy and safety of sildenafil in ED by ethnicity (white, black Asian) and age (≤45, 46-60, ≥61 years). METHODS: Data were pooled from 38 double-blind, placebo-controlled, flexible-dose trials. Most had starting sildenafil doses of 50 mg once daily, ~1 hour before sexual activity, with adjustment to 100 or 25 mg as needed. MAIN OUTCOME MEASURES: Change from baseline in International Index of Erectile Function erectile function (IIEF-EF) domain score assessed with analysis of covariance and a Global Assessment Question (GAQ; "Did the treatment improve your erections?") at endpoint assessed with logistic regression analysis. RESULTS: 4120 and 3714 men received sildenafil and placebo, respectively (2740 and 2671 White; 407 and 385 Black; 973 and 658 Asian). For sildenafil vs. placebo groups, overall treatment differences for IIEF-EF domain and GAQ were significant for each ethnic and age group (P<.0001); significant treatment-by-ethnicity and treatment-by-age interactions were also observed for change in IIEF-EF domain scores (P<.05), with differences significantly greater for White vs. Black (P<.0001), White vs. Asian (P=.0163), and Asian vs. Black (P=.0036) men. A significant treatment-by-ethnicity interaction was observed for GAQ (P=.0004). The OR comparison for GAQ was significantly greater (P=.0001) with sildenafil vs. placebo in White (OR=11.2) or Asian (OR=12.4) men vs. Black men (OR=5.1). Adverse-event rates were generally similar, with some age variations. CONCLUSIONS: Sildenafil is effective and well-tolerated regardless of ethnicity or age; however, treatment effects can vary.

Ethnicity and the prostate cancer experience: a qualitative metasynthesis.

OBJECTIVES: To summarize black and minority ethnic (BME) patients' and partners experiences of prostate cancer by examining the findings of existing qualitative studies. METHODS: We undertook a systematic metasynthesis of qualitative studies using a modified version of Noblit and Hare's "meta-ethnography" approach, with a 2000-2015 search of 7 databases. RESULTS: Thirteen studies of men from US and UK BME groups were included. We explored constructs with BME-specific features. Health care provider relationships, formation of a spiritual alliance with God (which enhanced the participants' feeling of empowerment and ability to cope with the cancer), and living on for others (generally to increase cancer awareness), often connected to spiritual regrowth, were the 3 constructs most commonly reported. A magnified effect from erectile dysfunction was also common. Initially, this affected men's disclosure to others about their cancer and their sexual problems, but eventually men responded by shifting their conceptualizations of masculinity to sustain self and social identities. There was also evidence of inequality resulting from financial constraints and adversity that necessitated resilience in coping. CONCLUSIONS: The prostate cancer experience of BME men and their partners is affected by a complex intersection of ethnicity with other factors. Health care services should acknowledge this. If providers recognize the men's felt masculinities, social identities, and spiritual beliefs and their shifting nature, services could be improved, with community as well as individual benefits. More studies are needed in diverse ethnic groups.

Correlates of men's sexual interest: a cross-cultural study.

INTRODUCTION: Low sexual desire has been studied more extensively in women than in men. AIM: The study aims to analyze the correlates of distressing lack of sexual interest and the self-assessed reasons for the lack of sexual interest among heterosexual men from three countries. METHODS: A web-based survey was completed by 5,255 men aged 18-75 years from Portugal, Croatia, and Norway. MAIN OUTCOME MEASURES: We used an item that assesses lack of sexual interest from the British NATSAL 2000. Anxiety and depression were measured with the SCL-ANX4 and SCL-DEP6. Relationship intimacy was measured using a five-item version of the Emotional Intimacy Scale. A shortened version of the Sexual Boredom Scale was used to assess proneness to sexual boredom in relation to the duration of relationship, and personal distress was evaluated using an item created for this study. RESULTS: Distressing lack of sexual interest lasting at least 2 months in the previous year was reported by 14.4% of the participants. The most prevalent comorbidity among these men was erectile difficulty (48.7%). Men with low confidence levels in erectile function, not feeling attracted to the partner, and those in long-term relationships were more likely to have experienced lack of sexual interest than were men with high confidence levels and those who felt attracted to their partner and those in shorter-term relationships. Professional stress was the most frequently reported reason for lack of sexual interest. Sexual boredom as a result of a long-term relationship was significantly and negatively correlated with the level of intimacy (r = -0.351, P < 0.001) and sexual satisfaction (r = -0.497, P < 0.001). CONCLUSIONS: Distressing lack of sexual interest in heterosexual men was associated with a number of intrapersonal (self-confidence in erectile function, stress), interpersonal (relationship duration, partner attractiveness), and sociocultural variables.

Socio-demographic and psychosocial correlates of erectile dysfunction among hypertensive patients.

OBJECTIVE: The main aim of the study was to estimate the prevalence of ED and the associated socio-demographic and psychological correlates among hypertensive patients from a rural multiethnic community in Malaysia. METHODS: A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The socio-demographic, health characteristics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of ErectileFunction-5 (IIEF-5) questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress, respectively. RESULTS: A total of 253 hypertensive patients comprising 178 (70.4%) Malays, 56 (22.1%) Chinese and 18 (7.5%) Indians participated. The mean age of participants was 59.8 ± 10.62 years. Overall, the prevalence rate of ED was 62%: 90 (35%) with moderate and 69 (27%) with severe ED. The prevalence rate of ED among those aged 65 years or older (83.1%) was significantly higher than those less than 65 years (51.8%), (p<0.001). Higher prevalence rates were also noted among the Chinese (78.6%) compared to Malays (59.6%) and Indians (50%) (p=0.021); lower education level (69.1%) (p=0.026), among hypertensive patients with concomitant diabetes mellitus (70.6%) (p=0.026) and WHR ≥ 0.9 (31.3%) (p=0.021). However, no significant association was found between depression, anxiety and stress scores with IIEF-5 score. CONCLUSION: The prevalence rate of ED among Malaysian hypertensive patients is high. The rate increases significantly with age, Chinese ethnicity, concomitant diabetes mellitus, lower education level, WHR and the number of pack years of smoking. ED should be properly recognized and managed in hypertensive patients.

Erectile dysfunction precedes and is associated with severity of coronary artery disease among Asian Indians.

INTRODUCTION: Erectile dysfunction (ED) and coronary artery disease (CAD) often share common risk factors, and there is growing evidence that ED might serve as a clinical marker for cardiovascular disease. Despite rising trends of CAD in Asian Indians, limited data are available on the prevalence of ED and its correlation with CAD severity in such patients. AIM: To study the prevalence of ED in Asian Indian patients undergoing coronary angiography and to assess if the severity of ED correlates with angiographic severity of CAD. METHODS: In all patients undergoing coronary angiography, ED was assessed using the International Index of Erectile Function-5 questionnaire. MAIN OUTCOME MEASURES AND RESULTS: Among 175 male patients, ED was present in 70%; patients with ED had a higher incidence of multivessel CAD (80% vs. 36%, P 0.001), diffuse CAD (81% vs. 34%, P 0.001), and higher number of mean coronary vessels involved compared with those without ED. Those with severe ED had higher prevalence of multivessel CAD and higher number of mean coronary vessels involved compared with those with milder grades of ED. Onset of symptoms of ED preceded symptoms of CAD by a mean of 24.6 months in 84% of patients. The presence of severe ED was associated with a 21-fold higher risk of having triple-vessel disease (odds ratio [OR] 21.94, 95% confidence interval [CI] 3.41-141.09, P = 0.001) and an 18-fold higher risk of having diffuse angiographic CAD (OR 17.91, 95% CI 3.11-111.09, P = 0.001). CONCLUSION: Asian Indians with angiographic CAD frequently have ED; symptoms of ED precede that of CAD in most patients. Incidence of multivessel and diffuse CAD is significantly more common in patients with ED. It is important for physicians to be aware of the close relationship between the two conditions so that patients with ED can have optimal risk stratification for concomitant CAD whenever required.

Ethnic differences in sexual dysfunction among diabetic and nondiabetic males: the Oxford Sexual Dysfunction Study.

INTRODUCTION: Erectile dysfunction (ED), premature ejaculation (PE), and reduced libido are common yet poorly investigated complications of diabetes especially among South Asians (SA). AIM: To determine possible variations in prevalence and interassociations of ED, PE, and reduced libido among SA and Europids with and without diabetes. METHOD: Men with diabetes and a randomly selected sample of age-matched nondiabetic men from 25 general practitioners in eight primary care trusts in the United Kingdom were invited to participate in a linguistically validated questionnaire-based study in English, Hindi, Urdu, Panjabi, Tamil, and Sinhala languages. MAIN OUTCOME MEASURES: ED, assessed by International Index of Erectile Function (IIEF-5), PE, evaluated using the Premature Ejaculation Diagnostic Tool, and libido, assessed by asking participants to grade their desire for sexual activity. RESULTS: Sample size was 510 (SA: 184, Europid: 326). Mean age was 56.9 ± 9.7 years. There was no difference in erectile function when assessed by IIEF between SA and Europids with diabetes (84.8% and 84.1%, respectively). The overall prevalence of PE was 28.8% (32.6% and 25.8% in those with and without diabetes, respectively, P = NS). Among men with diabetes, the prevalence of PE was 45.8% and 22.4% for SA and Europids, respectively (P < 0.001). In those without diabetes, this figure was 41.9% in SA and 20.2% in Europids (P < 0.001). There was a significant trend of increasing prevalence of PE with increasing severity grade of ED (P < 0.001). Reduced libido was reported by 26.9% men (32.8% and 22.0% in those with and without diabetes, respectively, P < 0.01), with no significant ethnic difference. The association between reduced libido and increasing severity grades of ED was also significant (P < 0.001). CONCLUSIONS: No significant difference was observed in the prevalence of ED between SA and Europid men with diabetes. PE was significantly more common in the SA men irrespective of their diabetes status.

Indigenous knowledge systems and attitudes towards male infertility in Mhondoro-Ngezi, Zimbabwe.

Male impotence and infertility are health and social problems that have resulted in significant suffering to men the world over. From an African perspective, and in Zimbabwe in particular, the taboo nature of male impotence and infertility carries a lot of mystique. Based on evidence from focus-group discussions, in-depth and key-informant interviews, this study reveals rural Shona people to have indigenous knowledge systems that trigger the investigation of signs of impotence (perceived as associated with male infertility) at infancy, puberty and after marriage. Male infertility carries overtones of failure, frustration, pain, social ostracism, stigma, marital instability, discomfiture and suicide. Intervention strategies to remedy perceived problems were exclusively sociocultural, involving the administration of traditional herbs and traditional healers' divination. Given the existence of indigenous knowledge systems for the investigation and mediation of male impotence and infertility, it is worth incorporating traditional healers in future strategies targeting these emasculating conditions.

Aging respectably by rejecting medicalization: Mexican men's reasons for not using erectile dysfunction drugs.

As lifestyle drug production and medical interest in geriatrics increase, the medicalization of aging and sexuality have become intertwined. Drugs like Viagra naturalize lifelong performance of phallocentric sex as a marker of healthy aging. Yet despite the ubiquity of medical aids for having "youthful" sex in older age, this article argues that having no or less sex can be a conscious strategy for embodying respectable aging. Based on ethnographic research in a Cuernavaca, Mexico, hospital urology department, this article shows that despite the traditional association of penetrative sex with successful masculinity, many older, working-class Mexican men faced with erectile difficulty reject "youthful" sexuality and drugs that facilitate it in order to embody a "mature" masculinity focused on home and family. This article argues that social encouragement and structural disincentives for medicalizing erectile difficulty encouraged men to interpret decreasing erectile function as natural and appropriate.

Quality of life in patients with erectile dysfunction in the Niger Delta region, Nigeria.

BACKGROUND: Erectile dysfunction (ED) in men is increasingly becoming a major problem worldwide. The damaging effects on the psyche and the anxiety regarding sexual performance and overall life satisfaction could be irreversible. AIMS: The objective of this study was to compare domains of quality of life (QOL) in men with ED in the Niger Delta region of Nigeria in order to determine the contextual social variables. METHOD: In a cross-sectional study, 400 male patients attending the general outpatient clinic between January and March 2009 were randomly assessed for ED and QOL, using abridged version of the International Index of Erectile function and the World Health Organization Quality of life instrument. RESULTS: A total of 166 (41.7%) subjects suffered from ED, 80 (48.2%) from medical illness, 56 (33.7%) from surgical problems and 30 (18.1%) from undiagnosed problems. Social relationships and psychological health indices of QOL were severely impaired in men with ED than the general, overall, physical and environmental health. CONCLUSION: An inference from this study suggests that sexual function promotes psychological well-being as well as interpersonal relationships. Therefore, monitoring these indices of QOL in men with ED is important to boost their confidence and self-esteem needed for a better QOL.

Decline in male sexual desire, function, and satisfaction during and after antiviral therapy for chronic hepatitis C.

BACKGROUND & AIMS: The recommended therapy for chronic hepatitis C, pegylated interferon and ribavirin for 24 or 48 weeks, has many known adverse side effects. The aim of this study was to evaluate the impact of antiviral therapy on male sexual health. METHODS: As part of the Study of Viral Resistance to Antiviral Therapy of Chronic Hepatitis C (Virahep-C), 260 men treated with pegylated interferon alfa-2a and ribavirin completed self-administered questionnaires concerning sexual desire, sexual function, including erectile and ejaculatory function, and sexual satisfaction before, during, and after treatment. RESULTS: Before therapy, 37% of men reported at least some degree of impairment in sexual desire and 44% reported dissatisfaction with their sexual life, while 26% reported impairment in erectile and 22% in ejaculatory function. During therapy, significant declines were observed in all components of sexual health compared with pretreatment. At the end of therapy (24 or 48 weeks), an estimated 38%-48% of men reported that overall sexual function was worse than before treatment. African American patients reported less impairment in sexual desire and satisfaction than Caucasian American patients during therapy. By 24 weeks after treatment, sexual desire and satisfaction improved and were comparable to baseline levels. However, among men who received 48 weeks of therapy, the estimated percentage of men reporting posttreatment erectile or ejaculatory problems remained higher than baseline, although persistent erectile impairment was limited to Caucasian American patients. CONCLUSIONS: Sexual impairment is common among men with chronic hepatitis C undergoing therapy with pegylated interferon and ribavirin and should be considered as a potential side effect of antiviral therapy.

A cross-sectional study for the analysis of clinical, sexual and laboratory conditions associated to Peyronie's disease.

INTRODUCTION: Although Peyronie's Disease (PD) was first described over 250 years ago, its precise etiology remains obscure. AIM: Analyze a variety of potential associated factors with PD, including erectile dysfunction. MATERIALS AND METHODS: This cross-sectional study included 83 consecutive men with PD and 252 age-matched controls. All men completed the International Index of Erectile Function (IIEF) and were evaluated regarding their clinical and demographic characteristics, comorbidities, and used medications. Anthropometric measures included body mass index and waist circumference (WC). Fasting blood glucose, lipid profile, total testosterone, and dehydroepiandrosterone-sulfate were determined. MAIN OUTCOME MEASURES: Clinical and laboratory characteristics associated to PD. RESULTS: The mean age was 59.2 + or - 10 years in the cases and 59.7 + or - 12 years in the controls. Marital status, current smoking, and excessive consumption of alcoholic beverages were similar between groups (P > 0.05). PD was more common among white skin color males (P = 0.001). The mean score for each IIEF domain and the androgen levels were similar in the two groups. Thiazides were the only medication associated to PD (P = 0.03). Dupuytren's disease was more frequent among individuals with PD (P = 0.001). The distribution of all other comorbidities investigated was similar between groups (P > 0.05). The characteristics WC > 102 cm and levels of low-density lipoprotein (LDL) > 130 mg/dL were more prevalent in the controls (P < 0.05). After multivariate analysis, white skin color (OR: 8.47, 95%CI: 1.98-36.24) and thiazide use (OR: 2.29, 95%CI: 1.07-4.90) were associated to PD, and LDL > 130 mg/dL (OR: 0.55, 95%CI: 0.32-0.92) and WC > 102 cm (OR: 0.53, 95%CI: 0.29-0.96) were inversely associated to PD. CONCLUSIONS: In this study, PD was more common among white skin colored males. An inverse relationship with the presence of elevated serum levels of LDL and WC was observed. We found no association with medications other than thiazides and comorbidities other than Dupuytren's disease. Androgen serum levels and sexual dysfunction had also no association to PD.

Racial disparities in urologic health care.

In the United States, disparities in health care delivery and access are apparent between different racial and ethnic groups. Minorities, including African Americans, often suffer disproportionately from disease compared to Caucasians. In the urologic arena, this is apparent in urologic cancer screening, treatment choices, and survival, as well as in the arena of chronic kidney disease, transplant allocation, and transplant outcomes. Latino men also seem to be affected more often by erectile dysfunction than Caucasian counterparts. Disparities such as these have been identified as a problem in the delivery of health care in the United States, and resources have been allocated to help allay the disparity. Through organizations such as the Cleveland Clinic Minority Men's Health Center, policy initiatives, and increased cultural awareness by physicians, steps can be made to reduce and eliminate health care disparities.

[Combination of improved sex therapy and sildenafil for erectile dysfunction in Uigur men: retrospective analysis of 2505 cases].

OBJECTIVE: The sex therapy is not yet popularized at present. This study aimed to evaluate the effect of the combination of the improved sex therapy and oral sildenafil on erectile dysfunction (ED). METHODS: A total of 3130 Uigur cases of ED received in Xinjiang Bogda Hospital were divided into a control group (n=625) and a trial group (n=2505), the former treated with oral sildenafil alone, and the latter by the combination of the improved genital therapy and sildenafil, both for 3 months and followed up at 6 and 12 months after the treatment. The therapeutic effects were evaluated and compared using IIEF-5. RESULTS: The IIEF-5 scores of the control group were 12.80 +/- 3.76 and 18.10 +/- 2.61 before and after the treatment, and 17.35 +/- 2.73 and 16.64 +/- 2.63 at 6 and 12 months, respectively, while those of the trial group were 12.73 +/- 3.52 and 19.06 +/- 4.07 before and af- ter the treatment, and 19.86 +/- 2.42 and 20.47 +/- 2.38 at 6 and 12 months, respectively, with statistically significant differences either between pre- and post-treatment (P < 0.05) or between the control and trial groups at 6 and 12 months (P < 0.05). CONCLUSION: The combination of the improved sex therapy and oral sildenafil is superior to sildenafil alone in the treatment of ED, and its efficacy is relatively stable at 12 months.

Association of lower urinary tract symptoms with sexual dysfunction: a cross-cultural study between Japanese and American men with localized prostate cancer.

OBJECTIVE: To assess the association of lower urinary tract symptoms (LUTS) with sexual function, and estimate the correlates of LUTS among Japanese and American men with localized prostate cancer. PATIENTS AND METHODS: In all, 343 Japanese men and 307 American men with prostate cancer were enrolled in the study. Sexual function and sexual bother were measured separately with the University of California-Los Angeles Prostate Cancer Index and obstructive/irritative voiding symptoms were measured with the American Urological Association Symptom Index (AUA SI). RESULTS: Japanese men had worse sexual function scores than the American men before treatment, whereas no differences were reported between Japanese and American men in sexual bother scores. Japanese and American men also did not differ meaningfully in AUA SI. However, those with moderate to severe LUTS reported significantly worse sexual bother scores than those with mild symptoms in both Japanese and American men (P = 0.004 and <0.001, respectively). The Japanese men were more likely to have LUTS than were American men (odds ratio 1.60, P = 0.029). Age and sexual function were highly associated with LUTS (odds ratio 1.35, P = 0.027; and 0.652, P = 0.001, respectively). The comorbidity count was independently associated with worse urinary symptoms (odds ratio 1.23, P = 0.015). CONCLUSIONS: We posit that cultural differences in the meaning or salience of sexual functioning, and the interpretation of the questionnaire in quality-of-life surveys, might explain the different profiles in the association of LUTS with sexual activity in Japanese and American men with localized prostate cancer.

Sexual activity of middle-aged women coupled with a male partner in Japan.

OBJECTIVE: To assess the sexual activity of women with male partners in Japan. METHODS: An original web-based questionnaire was conducted. A total of 2593 women in five age groups (20s, 30s, 40s, 50s, and 60s or older) were randomly invited to participate. Of the 1077 (41.5%) respondents, data for 883 women with partners were evaluated. Age and 15 items related to sexual activity and social background were analyzed. Women who stated that they neither had sexual activity with a partner nor had frustration with a partner's erectile dysfunction (ED) were defined as low sexuality (LS) subjects. Some subjects in the LS group were psychologically serious cases who did not feel the importance of a sexual relationship with their partner. These subjects were selected and defined as high-risk LS (HLS) subjects. RESULTS: Of the participants, 36.6% (n = 323) stated that they did not have sexual activity with their partner, and 30.7% (n = 271) and 21.7% (n = 192) were categorized as LS and HLS subjects, respectively. The percentage of HLS subjects increased significantly with age: 2.0%, 5.6%, 18.6%, 36.1% and 41.8% in the 20s, 30s, 40s, 50s, and 60s or older age groups, respectively. Age and unemployment status were independent predictors of HLS behavior. CONCLUSION: A high proportion of Japanese middle-aged women with a male partner have low sexual activity.

Sex among Asian men and women: the Global Better Sex Survey in Asia.

OBJECTIVES: To explore by a pooled subanalysis of the Global Better Sex Survey sexual aspirations and unmet needs of men and women from Hong Kong, Indonesia, Japan, Malaysia, Singapore, South Korea, Taiwan, and Thailand. METHODS: To qualify, respondents must have had sexual intercourse at least once in the past 12 months. Women must have had heterosexual intercourse. Data were weighted by population size between countries. RESULTS: Of 3538 Asian respondents (1776 men and 1762 women), 52% were aged <40 years, 40% were aged 40-59 years, and 8% were aged >or=60 years. The majority were married or in a relationship. Men and women reported having sexual intercourse 5.1 and 4.0 times monthly, respectively. Attraction to partner, foreplay, intercourse, and achieving orgasm were important to most men and women. Two thirds were less than very satisfied with their sex life, and 36% of men were interested in improving sex. For a good sexual experience, the man's ability to get and maintain an erection and erection hardness were important to the majority of Asian men and women. Few respondents reported using a prescription erectile dysfunction medication, but many showed interest in using these medications to improve their sex lives. A comparison between individual countries suggests that attitudes about sex differ from country to country, and between men and women in each country. CONCLUSIONS: Sex is very important to Asian men and women, but many of them are not fully satisfied with their sex lives and want to improve them.

Ramadan fasting triggering koro-like symptoms during acute alcohol withdrawal: a case report from Oman.

This article describes a case of koro-like symptoms from Oman associated with alcohol withdrawal and illustrates how the socio-cultural practices of Ramadan-fasting affected the patterning and timing of presentation of severe alcohol withdrawal symptoms. The patient was severely distressed by the delusion that his penis had been amputated. The acute anxiety involving this delusion appears to be conceptually and phenomenologically similar to koro.