Exploring complex links: inflammatory rheumatic diseases and men's health.

This article examines the complex interactions between inflammatory rheumatic diseases (IRDs) and men's health. It delves into the effects of IRDs on reproductive health, erectile dysfunction, prostate involvement, male osteoporosis, body composition, physical activity, and coping mechanisms. The findings show that the prevalence of sexual dysfunction varies among different diseases, underscoring the necessity for comprehensive counseling. The link between IRDs and prostate health, with a substantial rise in benign prostatic hyperplasia among IRD patients, demonstrates the condition's importance. In contrast to popular belief, osteoporosis mostly affects women; the current study highlights the growing identification of male osteoporosis, particularly in the setting of IRDs. Male RA patients had a significant loss in bone mineral density, highlighting the importance of increasing awareness and tailored therapy to address osteoporosis in men. IRDs affect body composition, with male RA patients showing imbalances characterized by decreased lean body mass and increased fat mass. Given the dynamic nature of these conditions, coping with IRDs necessitates thorough and individualized diversified approaches. The complex link between IRDs and men's health demands continuing research, including longitudinal studies and tailored therapies. The essay promotes a patient-centered approach, recognizing the unique obstacles that males with IRDs confront.

Long-Term Psychological and Physiological Effects of Male Sexual Trauma.

Male sexual trauma presents multiple clinical challenges. Although the topic has received increased attention in the last couple decades, male sexual trauma continues to be underreported and underrecognized. This study aimed to investigate the long-term effects of sexual trauma for men who were victimized within an institutional environment by a person in a position of power. This study included data from 47 adult men who were victims of sexual abuse or misconduct by an assigned physician at a higher education academic institution between 1966 and 2003. A primary finding was elevated rates of intimacy and sexual problems and erectile dysfunction, which started shortly after the abuse and persisted over time. We found that there was an association between intimacy and sexual problems and difficulty maintaining employment, drug addiction, erectile dysfunction, and loss of meaningful and romantic relationships. Levels of potential psychopathology were prominently linked to loss of sexual interest or pleasure, intimacy concerns, and loss of intimate and other personal relationships. Men who experienced sexual abuse as adults within an institutional environment developed long-standing patterns of interpersonal and professional problems. This study emphasizes the need for nuanced screening, evaluation, and treatment for male sexual trauma.

More Efficient Approach: Independent Diagnostic Value of Audiovisual Sexual Stimulation for Psychogenic Erectile Dysfunction.

The diagnostic value of audiovisual sexual stimulation (AVSS) for psychogenic erectile dysfunction (ED) is still unclear. We investigated the independent diagnostic value and optimal cut-off parameter of AVSS for psychogenic ED. All participants had received the AVSS test and nocturnal penile tumescence and rigidity (NPTR) monitoring at least twice. ED patients were divided into psychogenic ED and organic ED according to NPTR examination. The diagnostic accuracy of AVSS parameters was evaluated with the receiver operating characteristic (ROC) curve, and the Youden index was employed to determine the optimal diagnostic cut-off values. A total of 346 patients with ED and 60 healthy men were included in this study, among which 162 and 184 cases of psychogenic and organic ED were identified based on NPTR, respectively. When comparing the two ED groups, the area under the curve (AUC) of AVSS parameters was 0.85-0.89. Six-selected AVSS parameters could precisely diagnose psychogenic ED, exhibiting increased diagnostic specificity compared with corresponding sensitivity. When comparing psychogenic ED with the control group, the AUC of the tumescence of the tip was superior to the AUC other parameters (0.81 vs. 0.58, 0.66, 0.59, 0.53, 0.68), and the best determined diagnostic cut-off value was the tumescence of the tip < 29.87%. Independent AVSS could diagnose psychogenic ED objectively and effectively, and its diagnostic value was highest when 1.50% ≤ tumescence of the tip < 29.87%.

Sexual Outcomes after Conservative Management for Patients with Localized Penile Cancer.

BACKGROUND: Men with localized invasive penile cancer (PC) can be treated with organ-sparing treatments with different functional and aesthetical outcomes. Thus, the aim of this study is to investigate sexual outcomes in patients with PC confined to the glans that underwent wide local excision (WLE) vs. glansectomy with urethral glanduloplasty. METHODS: Complete data from 60 patients with PC were analyzed at our institution from 2017 to 2022. Patients were asked for personal habits and clinical features. PC was assessed with a clinical visit and imaging techniques. At the outpatient follow-up visit or phone call, all patients compiled the Changes in Sexual Function Questionnaire (CSFQ) and the International Index of Erectile Function in its short 5-item form (IIEF-5). Erectile function (EF) impairment was categorized using Cappelleri's criteria. RESULTS: Overall, 34 patients with PC confined to the glans (c ≤ T2N0) were included. Of those, 12 underwent WLE and 22 underwent glansectomy with urethral glanduloplasty. Using multivariable logistic regression, glansectomy (OR: 3.49) and diabetes (OR: 2.33) were associated with erectile disfunction (IEEF < 22). Meanwhile, using multivariable linear regression analysis, younger patients (Coeff: -2.41) and those that underwent glansectomy (Coeff: -7.5) had a higher risk of sexual function impairment, according to the CSFQ. CONCLUSIONS: Patients with PC ≤ T2N0 that underwent WLE have better outcomes in terms of sexual functioning than the patients who underwent glansectomy and uretheral gladuloplasty. Further research is needed to clarify the outcomes of penile-sparing surgery, to inform patients in pre-surgical counseling more comprehensively, and to meet their post-operative expectations more effectively.

Identification of Emotional Spectrums of Patients Taking an Erectile Dysfunction Medication: Ontology-Based Emotion Analysis of Patient Medication Reviews on Social Media.

BACKGROUND: Patient medication reviews on social networking sites provide valuable insights into the experiences and sentiments of individuals taking specific medications. Understanding the emotional spectrum expressed by patients can shed light on their overall satisfaction with medication treatment. This study aims to explore the emotions expressed by patients taking phosphodiesterase type 5 (PDE5) inhibitors and their impact on sentiment. OBJECTIVE: This study aimed to (1) identify the distribution of 6 Parrot emotions in patient medication reviews across different patient characteristics and PDE5 inhibitors, (2) determine the relative impact of each emotion on the overall sentiment derived from the language expressed in each patient medication review while controlling for different patient characteristics and PDE5 inhibitors, and (3) assess the predictive power of the overall sentiment in explaining patient satisfaction with medication treatment. METHODS: A data set of patient medication reviews for sildenafil, vardenafil, and tadalafil was collected from 3 popular social networking sites such as WebMD, Ask-a-Patient, and Drugs.com. The Parrot emotion model, which categorizes emotions into 6 primary classes (surprise, anger, love, joy, sadness, and fear), was used to analyze the emotional content of the reviews. Logistic regression and sentiment analysis techniques were used to examine the distribution of emotions across different patient characteristics and PDE5 inhibitors and to quantify their contribution to sentiment. RESULTS: The analysis included 3070 patient medication reviews. The most prevalent emotions expressed were joy and sadness, with joy being the most prevalent among positive emotions and sadness being the most prevalent among negative emotions. Emotion distributions varied across patient characteristics and PDE5 inhibitors. Regression analysis revealed that joy had the strongest positive impact on sentiment, while sadness had the most negative impact. The sentiment score derived from patient reviews significantly predicted patient satisfaction with medication treatment, explaining 19% of the variance (increase in R2) when controlling for patient characteristics and PDE5 inhibitors. CONCLUSIONS: This study provides valuable insights into the emotional experiences of patients taking PDE5 inhibitors. The findings highlight the importance of emotions in shaping patient sentiment and satisfaction with medication treatment. Understanding these emotional dynamics can aid health care providers in better addressing patient needs and improving overall patient care.

Efficacy of online cognitive behavioral therapy for nonorganic erectile dysfunction in reproductive-age males during the COVID-19 pandemic: a randomized wait list-controlled trial.

BACKGROUND: Previous research has documented the impact of the COVID-19 pandemic on male sexual and mental health. However, no prior study has evaluated the efficacy of online cognitive behavioral therapy (CBT) during the COVID-19 pandemic for treating nonorganic erectile dysfunction (ED) by improving negative emotions and self-esteem. AIM: To test the efficacy of online CBT for nonorganic ED during the COVID-19 pandemic in Shanghai, China. METHODS: A randomized controlled trial was conducted during the COVID-19 pandemic. Paired t-tests and 1-way analysis of variance were used to analyze and compare erectile functioning, self-esteem, and emotional state between and within groups. OUTCOMES: The main outcome measures included scores on the 5-item International Index of Erectile Function, Rosenberg Self-esteem Scale, 9-item Patient Health Questionnaire, and 7-item Generalized Anxiety Disorder scale to evaluate erectile functioning, self-esteem, depression, and anxiety, respectively. RESULTS: In the CBT group, erectile functioning, intercourse satisfaction, orgasmic functioning, sexual desire, and overall satisfaction were significantly improved at posttreatment as compared with pretreatment (P < .05). After treatment, group differences in emotional state and self-esteem were observed between the CBT group and the control group. Results revealed that the CBT group had significantly better scores than the control group at posttreatment on the Rosenberg Self-esteem Scale (mean ± SD, 30.43 ± 6.51 vs 22.67 ± 10.74), Patient Health Questionnaire (7.07 ± 2.74 vs 11.07 ± 4.41), and Generalized Anxiety Disorder scale (8.36 ± 1.97 vs 11.13 ± 3.94; P < .05). CLINICAL IMPLICATIONS: This study represents an important advance in understanding of the efficacy of online CBT for treating nonorganic ED in reproductive-age males during the COVID-19 pandemic. STRENGTHS AND LIMITATIONS: The study participants, treatment modality, and COVID-19 pandemic background of this study are innovative and therefore strengths. However, our study has several limitations-namely, its sample size and use of self-report data to measure erectile functioning due to the pandemic. Further studies should incorporate sexual functioning-monitoring instruments as well as self-report data to measure erectile function. CONCLUSION: Online CBT clearly improved the emotional state and self-esteem of patients with ED during the COVID-19 pandemic.

Altered White Matter Structural Network Connectivity Associated with Cognitive Declines in Psychogenic Erectile Dysfunction.

It has been reported that individuals with psychogenic erectile dysfunction (pED) potentially suffer from cognitive declines. Despite that increasing neuroimaging studies have demonstrated abnormalities of cerebral structural changes in pED, the association between altered white matter (WM) structural network and cognitive impairments remains unclear. Hence, this study aimed to explore the relationship between WM structural network connectivity and cognitive performance in patients with pED. Forty pED patients and 33 healthy controls (HCs) were recruited to perform cognitive assessments, and diffusion tensor imaging scans. We firstly constructed the WM structural network and applied the machine learning method to identify the important features. Then, we examined group differences in cognitive assessments, WM structural network connectivity within the identified features, and associations between altered WM structural network connectivity and cognitive scores in pED patients. From 26,896 features of DTI data, 24 important features were identified by K-Nearest Neighbor classification with a satisfactory accuracy (78%). Compared with HCs, we found that pED patients showed higher fractional anisotropy (FA) values between left transverse temporal sulcus and left supramarginal gyrus, and lower FA values between left suborbital sulcus and left para-hippocampal part of the medial occipito-temporal gyrus in pED patients. Furthermore, the increased FA between left transverse temporal sulcus and left supramarginal gyrus was observed to be negatively associated with impaired delayed memory. Overall, our findings provide new insights into WM network alterations associated with impaired cognitive functions in pED, which may unravel the potential neural mechanisms underlying the cognitive impairments of pED patients.

Precarious Manhood Beliefs Are Positively Associated with Erectile Dysfunction in Cisgender Men.

The notions that manhood is hard to attain, easy to lose, and needs to be proven via public action constitute precarious manhood beliefs (PMB). PMB is a new concept and it remains unclear whether and how PMB relate to erectile dysfunction (ED) in cisgender men. The ability to achieve an erection remains considered as a cornerstone of masculinity and sexual performance can be conceived as a proof of one's masculinity. In this context, ED can be received as sexual failure and a threat to a man's masculinity and sense of adequacy. For these reasons, the hypothesis that PMB are associated with ED warranted empirical testing. In an anonymous online survey focusing on men's mental health conducted in German-speaking countries of Europe, 507 cisgender men (Mage = 44.2, SDage = 15.2) completed measures on PMB, sexual function, self-stigma, social desirability, and conformity to traditional masculinity ideology (TMI). Multilinear regression analysis with stepwise introduction of relevant covariates evaluated potential associations between PMB and ED. Of a 507 cisgendered male sample, 63.1% reported an increased risk for ED based on previously established cutoff points. Elevated levels of PMB endorsement among the men predicted reduced sexual and erectile function in all models, even when accounting for relevant control variables such as age, education, self-stigma, social desirability, or conformity to TMI. Group comparisons revealed that the men suffering from ED showed higher levels of PMB endorsement but not self-stigma nor TMI relative to men without ED. PMB are significantly associated with ED. While determining causality will require further study, our results may support the hypothesis that higher levels of PMB endorsement may lead to increased tension to perform sexually, resulting in increased psychological pressure and a higher risk to develop ED.

Recreation use of phosphodiesterase type 5 inhibitors, the other side of erectile dysfunction.

To the Editor, In 1998 Sildenafil was approved by the Food and Drug Administration as first line therapy for erectile dysfunction. Since then, phosphodiesterase type 5 inhibitors (PDE5i) represent the first-line treatment of erectile dysfunction (ED), improving physiological erectile function, sexual orgasmic function, psychological self-esteem, couples' relationship, and quality of life. [...].

Men's Feminist Identification and Reported Use of Prescription Erectile Dysfunction Medication.

We analyzed data from the 2018 Sex in Canada survey (n = 1,015 cisgender men) to examine the association between feminist identification and reported use of prescription ED medication (EDM) during men's last sexual encounter. Feminist-identified men were substantially more likely to report EDM use than non-feminist men, even after controlling for alcohol use before sex, erection difficulties, sexual arousal, sexual health, mental health, and physical health. One explanation is that feminist men may use EDM to bolster their masculinity when it is otherwise threatened by their identification as feminist. Another is that non-feminist men may be less likely to use prescription EDM because they view accessing healthcare services as a threat to their masculinity. It is also possible that feminist men are more likely to use EDM because they wish to maintain an erection to better please their partner. Lastly, feminist men may be more honest about EDM use than non-feminist men, even though rates are similar. Regardless of the exact reason, therapists can use these results to tailor sexual health messages to clients based on feminist identification. Future work could employ qualitative methods to understand why feminist men report higher rates of EDM use than non-feminist men.

Tadalafil improves erectile dysfunction and quality of life in men with cirrhosis: a randomized double blind placebo controlled trial.

BACKGROUND AND AIMS: Patients with cirrhosis have high prevalence of erectile dysfunction (ED). The aim of this study was to study the efficacy and safety of tadalafil for ED in patients with cirrhosis. METHODS: 140 cirrhotic males with ED were randomized into tadalafil 10 mg daily (n = 70) or placebo (n = 70) for 12 weeks. ED was diagnosed if erectile function (EF) domain score was < 25 in International Index of Erectile Function (IIEF) questionnaire. The erectile function domain consists of six questions concerning erection frequency, erection firmness, frequency of partner penetration, frequency of maintaining erection after penetration, ability to maintain erection to completion of intercourse and confidence in achieving and maintaining erection. Primary outcome was proportion of patients having an increase in > 5 points in EF domain of the IIEF. Generalized Anxiety Disorder 7 (GAD-7) questionnaire was used for screening and severity measuring of GAD. The presence of depression was screened using the Patient Health Questionnaire (PHQ-9) and the assessment of health related quality of life was done using the Short Form (36) Health Survey. RESULTS: At the end of 12 weeks, more patients in tadalafil group achieved > 5 points increase in the EF domain of the IIEF when compared with the placebo group [44(62.9%) vs. 21(30%), p < 0.001]. At the end of 12 weeks, patients receiving tadalafil had significantly more change in scores on the erectile function domain, orgasmic function domain, intercourse satisfaction domain, overall satisfaction domain, erection vaginal penetration rates and successful intercourse; significantly more decline in the GAD-7 and PHQ-9 scores; significantly more improvement in scores of five of the eight domains of SF-36 (general health perception, vitality score, social functioning, role emotional and mental health) and the mental component summary rates when compared with placebo. The development of side effects and the changes in HVPG were not significantly different between the two groups. CONCLUSIONS: Tadalafil therapy may enhance erectile function, improve anxiety, depression and quality of life; and is well tolerated by men with cirrhosis (CTP score < 10) and ED. However, further larger and long-term studies are needed to confirm these results and look for rarer side effects of using tadalafil in patients with cirrhosis. TRIAL REGISTRATION: ClinicalTrials.gov identifier number NCT03566914; first posted date: June 25, 2018.

Erectile Function, Sexual Satisfaction, and Cognitive Decline in Men From Midlife to Older Adulthood.

BACKGROUND AND OBJECTIVES: Vascular theories of cognitive aging have focused on macrovascular changes and cognitive decline. However, according to the artery-size hypothesis, microvascular changes, such as those that underlie changes in erectile function, may also play an important role in contributing to cognitive decline. Thus, we examined associations between erectile function, sexual satisfaction, and cognition starting in middle age because this represents a transition period where declines in these areas emerge. RESEARCH DESIGN AND METHODS: We examined 818 men from the Vietnam Era Twin Study of Aging across three waves at mean ages 56, 61, and 68. Erectile function and sexual satisfaction were measured using the International Index of Erectile Function. Cognitive performance was measured using factor scores for episodic memory, executive function, and processing speed. We tested multilevel models hierarchically, adjusting for demographics, frequency of sexual activity, and physical and mental health confounders to examine how changes in erectile function and sexual satisfaction related to changes in cognitive performance. RESULTS: Lower erectile function at baseline was related to poorer performance in all cognitive domains at baseline and faster declines in processing speed over time. However, baseline sexual satisfaction was unrelated to cognitive performance. Decreases in erectile function and sexual satisfaction were both associated with memory decline. DISCUSSION AND IMPLICATIONS: Decreasing sexual health may signal an increased risk for cognitive decline. We discuss potential mechanisms, including microvascular changes and psychological distress. Discussing and tracking sexual health in middle-aged men may help to identify those likely to face memory decline.

Continuous Psychological Nursing Based on Grey Clustering Algorithm in Patients after Transurethral Resection of Prostate.

Objective: To explore the effect of continuous psychological nursing based on the grey clustering algorithm on erectile function, bad psychological emotion, and complications in patients after transurethral resection of prostate (TURP). Methods: 98 patients who underwent TURP were randomly divided into observation and control groups (routine nursing). The observation group first used the grey clustering algorithm to evaluate the psychological intelligence, found patients with abnormal psychological behavior, and then implemented continuous psychological nursing combined with pelvic floor muscle exercise. The patients were followed up for 4 months. The International Index of Erectile Function-5 (IIEF-5), the incidence of complications, the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA) scores, and the nursing satisfaction were analyzed and compared between these two groups. Results: The grey clustering algorithm can accurately reflect the characteristics of patients' psychological changes. After targeted nursing, compared with the control group, the IIEF-5 in the observation group was higher [(24.87 ± 1.85) vs. (22.24 ± 1.47), P < 0.05], the incidence of total complications was lower (10.20% vs. 26.53%, P < 0.05), the score of HAMA was lower [(6.11 ± 2.57) vs. (10.98 ± 2.29), P < 0.05], the score of HAMD was lower [(6.97 ± 2.85) vs. (11.35 ± 2.19), P < 0.05], and the nursing satisfaction was higher (100% vs. 85.71%, P < 0.05). Conclusion: Mental intelligence evaluation based on the grey clustering algorithm combined with pelvic floor muscle exercise can significantly improve the rehabilitation effect of erectile function in patients after TURP, reduce the incidence of postoperative complications, and alleviate patients' anxiety and depression.

Current Techniques for the Objective Measures of Erectile Hardness.

INTRODUCTION: One of the most discussed topics in the urology provider's office is that of the male penile erection. Moreover, this is also a frequent basis for consultation by primary care practitioners. As such, it is essential that urologists are familiar with the various means by which the male erection may be evaluated. OBJECTIVES: This article describes several techniques presently available that may serve to objectively quantify the rigidity and hardness of the male erection. These techniques are meant to bolster information gathered from the patient interview and physical examination to better guide patient management. METHODS: An extensive literature review was performed examining publications in PubMed on this subject, including corresponding contextual literature. RESULTS: While validated patient questionnaires have been routinely employed, the urologist has many additional means available to uncover the extent of the patient's pathology. Many of these tools are noninvasive techniques that involve virtually no risk to the patient and take advantage of pre-existing physiologic properties of the phallus and its blood supply to estimate corresponding tissue stiffness. Specifically, Virtual Touch Tissue Quantification which precisely quantifies axial and radial rigidity, can provide continuous data on how these forces change over time, thus providing a promising comprehensive assessment. CONCLUSION: Quantification of the erection allows for the patient and provider to assess response to therapy, aids the surgeon in choice of appropriate procedure, and guides effective patient counseling regarding expectation management. Rohrer GE, Premo H, Lentz AC. Current Techniques for the Objective Measures of Erectile Hardness. Sex Med Rev 2022;10:648-659.

Impact of infertility duration on male sexual function and mental health.

PURPOSE: This study aimed to explore whether infertility duration has an impact on the sexual function and mental health of men from infertile couples. METHODS: We conducted a case-control study of 558 men from infertile couples, and the participants were divided into four groups based on their infertility duration: group I: ≤ 2 years; group II: 2-5 years; group III: 5-8 years; and group IV: > 8 years. Sexual function and mental disorders were measured using the International Index of Erectile Function-15 (IIEF-15), Premature Ejaculation Diagnostic Tool (PEDT), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9) separately. RESULTS: As the years of infertility duration increase, the total IIEF-15 score and four domains (sexual desire, orgasmic function, erectile function, and intercourse satisfaction) significantly decrease (p < 0.05). The PEDT score gradually increases significantly (p < 0.05). Increased infertility duration is an independent risk factor for erectile dysfunction and premature ejaculation (p < 0.05). However, increased infertility duration is not a risk factor for depression and anxiety (p > 0.05). CONCLUSIONS: Our study is the first time to use the infertility duration as an independent variable and group this variable to analyze its impact on the sexual function and mental health of men from infertile couples comprehensively and systematically. The increased infertility duration is an independent risk factor for the occurrence of sexual dysfunction but not for mental disorders. In the process of infertility treatment, sexual health and mental health cannot be ignored, especially for patients with prolonged infertility.

Effects of HPV Positivity in Women on Couples Sexual Behavior.

We aimed to analyze the effect of HPV positivity in women, on women's psychology, sexual health, and male sexuality. Participants in the study were sexually active patients with high-risk HPV positivity and without any cancerous and precancerous lesions in the pathological examination. Participants and their partners' sexual health were evaluated with the FSFI questionnaire and the International Index of Erectile Function (IIEF) Score. The Beck anxiety inventory (BAI) form was used to determine participants' anxiety status. The presence of premature ejaculation was analyzed using the premature ejaculation diagnosis tool (PEDT) form. Comparison of FSFI scores at the time of diagnosis and one month later revealed a significant decrease (18.1 vs 15.1, p = 0.001). Partners' IEFF score decreased from 27.7 at diagnosis to 25.5(p = 0.001). The mean BAI score rose from 13.9 at diagnosis to 25.5 one month later (p = 0.001). Participants' partners had a significantly worse PEDT score one month after diagnosis (6.0 vs 10.8, p = 0.001). The present study demonstrated a significant deterioration in female psychological and sexual health caused by HPV positivity. Moreover, after their partner's diagnosis with HPV positivity, men were significantly more likely to suffer from erectile dysfunction and premature ejaculation.

Current Techniques for the Objective Measures of Erectile Hardness.

INTRODUCTION: One of the most discussed topics in the urology provider's office is that of the male penile erection. Moreover, this is also a frequent basis for consultation by primary care practitioners. As such, it is essential that urologists are familiar with the various means by which the male erection may be evaluated. OBJECTIVES: This article describes several techniques presently available that may serve to objectively quantify the rigidity and hardness of the male erection. These techniques are meant to bolster information gathered from the patient interview and physical examination to better guide patient management. METHODS: An extensive literature review was performed examining publications in PubMed on this subject, including corresponding contextual literature. RESULTS: While validated patient questionnaires have been routinely employed, the urologist has many additional means available to uncover the extent of the patient's pathology. Many of these tools are noninvasive techniques that involve virtually no risk to the patient and take advantage of pre-existing physiologic properties of the phallus and its blood supply to estimate corresponding tissue stiffness. Specifically, Virtual Touch Tissue Quantification which precisely quantifies axial and radial rigidity, can provide continuous data on how these forces change over time, thus providing a promising comprehensive assessment. CONCLUSION: Quantification of the erection allows for the patient and provider to assess response to therapy, aids the surgeon in choice of appropriate procedure, and guides effective patient counseling regarding expectation management.

Disorders of Ejaculation: An AUA/SMSNA Guideline.

PURPOSE: Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with premature ejaculation (PE), while men who experience difficulty achieving sexual climax may be diagnosed with delayed ejaculation (DE). The experience of many clinicians suggest that these problems are not rare and can be a source of considerable embarrassment and dissatisfaction for patients. The role of the clinician in managing PE and DE is to conduct appropriate investigation, to provide education, and to offer available treatments that are rational and based on sound scientific data. MATERIALS AND METHODS: The systematic review utilized to inform this guideline was conducted by a methodology team at the Pacific Northwest Evidence-based Practice Center. A research librarian conducted searches in Ovid MEDLINE (1946 to March 1, 2019), the Cochrane Central Register of Controlled Trials (through January 2019) and the Cochrane Database of Systematic Reviews (through March 1, 2019). An update search was conducted on September 5, 2019. Database searches resulted in 1,851 potentially relevant articles. After dual review of abstracts and titles, 223 systematic reviews and individual studies were selected for full-text dual review, and 8 systematic reviews and 59 individual studies were determined to meet inclusion criteria and were included in the review. RESULTS: Several psychological health, behavioral, and pharmacotherapy options exist for both PE and DE; however, none of these pharmacotherapy options have achieved approval from the United States Food and Drug Administration and their use in the treatment of PE and DE is considered off-label. CONCLUSION: Disturbances of the timing of ejaculation can pose a substantial impediment to sexual enjoyment for men and their partners. The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes.