Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic.

Patients with diabetes mellitus (DM) were more often hypogonadal than normal fasting glucose subjects. The aim of this investigation is the assessment of characteristics and psychobiological correlates of DM associated with hypogonadism (DMAH). The Structured Interview SIEDY was used along with several biochemical, psychological and instrumental investigations in a series of more than 1200 patients with erectile dysfunction (ED); 16% of whom with type II DM. Hypogonadism was defined as circulating total testosterone (T) below 10.4 nmol/l. The prevalence of hypogonadism was 24.5% in DM versus 12.6% in the rest of the sample (P < 0.0001); differences in the prevalence of hypogonadism retained significance after adjustment for age and BMI. DMAH was associated with typical hypogonadism-related symptoms, such as reduction in sexual desire, leading to a decreased number of sexual attempts, and with higher depressive symptomatology. In DMAH, testis size and LH concentrations were significantly reduced, suggesting a central origin of the disease. At penile Duplex ultrasound examination, diabetic patients and in particular hypogonadal type II diabetic patients showed lower levels of basal and dynamic (after PGE1 injection) peak systolic velocity and acceleration, when compared to the rest of the sample, even after adjustment for age and BMI. Our results show that hypogonadism is frequently associated with type II DM, at least in the 6th decade. DMAH might exacerbate sexual dysfunction by reducing libido and mood and further compromising penile vascular reactivity.

Psychobiological correlates of smoking in patients with erectile dysfunction.

Although it is clear that cigarette abuse is closely linked to sexual dysfunction, it is still unclear which are the psychobiological correlates of smoking among individuals with sexual dysfunction. The aim of the present study is the assessment of the organic, psychogenic and relational correlates of erectile dysfunction (ED) in outpatients with different smoking habits. We studied the psychobiological correlates of smoking behaviour in a consecutive series of 1150 male patients, seeking medical care for ED. All patients were investigated using a Structured Interview (SIEDY), which explores the organic, relational and intra-psychic components of ED, and a self-administered questionnaire for general psychopathology (MHQ). In addition, several biochemical and instrumental parameters were studied, to clarify the biological components underlying ED. Current smokers (CS) showed a higher activation of the hypothalamus-pituitary-testis axis (higher LH, testosterone and right testicular volume) and lower levels of both prolactin and TSH. Hormonal changes were reverted after smoking cessation. CS showed a higher degree of somatized anxiety and were more often unsatisfied of their occupational and domestic lifestyle. Smoking, as part of a risky behaviour, was significantly associated with abuse of alcohol and cannabis. Both CS and past smokers (PS) showed an impairment of subjective and objective (dynamic peak systolic velocity at penile duplex ultrasound) erectile parameters. This might be due to a direct atherogenic effect of smoking, a cigarette-induced alteration of lipid profile (higher triglyceride and lower HDL cholesterol in CS than in non-smokers or PS), or due to a higher use of medications potentially interfering with sexual function. This is the first comprehensive evaluation of the biological and intrapsychic correlates to the smoking habit. Our report demonstrates that smoking has a strong negative impact on male sexual life, even if it is associated at an apparently more sexual-favourable hormonal milieu.

Difficulties in achieving vs maintaining erection: organic, psychogenic and relational determinants.

Achieving and maintaining a penile erection are two essential components of the male sexual response. It has recently been suggested that distinct molecular mechanism could underlie the two disturbances. The aim of the present study is to verify possible clinical differences on pathogenetic factors underlying difficulties of achieving and maintaining an erection. We studied a consecutive series of 560 patients (aged 51.9+/-12.8 y old) reporting erectile dysfunction (ED), using SIEDY structured interview. Patients were classified into two distinct categories: those with difficulties in maintaining, rather than achieving, an erection (sample A) and those with main problems in achieving an erection (sample B). A complete physical examination and a series of metabolic, biochemical, hormonal, psychometric, penile vascular tests and nocturnal penile tumescence and rigidity evaluations (NPT) were also performed. Sample B patients showed a higher prevalence of organic conditions related to ED, when compared with sample A as confirmed by higher SIEDY scale 1 scores (3[1-5] vs 1[0.1-3] for sample B vs sample A, respectively; P < 0.0001) which explores organic component of ED and higher prevalence of pathological instrumental parameters. No difference among groups was observed for SIEDY scale 2 (relational component) and SIEDY scale 3 (intrapsychic component) of ED. In conclusion, this study shows for the first time that patients with difficulties in maintaining erection are less likely to be affected by organic disturbances interfering with sexual function, when compared with those unable to achieve a valid erection.

Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction.

We studied the psychological and biological correlates of hypoactive sexual desire (HSD) in a consecutive series of 428 patients with erectile dysfunction (ED), by using the structured interview SIEDY. A complete physical examination and a series of biochemical, hormonal, psychometric, and penile vascular tests were also performed. Among the patients studied, 22.8% reported a mild, 12.9% a moderate, and 4.6% a complete loss of sexual interest. Patients reporting HSD showed significantly lower testosterone (T) levels than the rest of the sample, although the prevalence of hypogonadism (T<10 nM) was comparable in the two groups. Only a minority (<2%) had severe hyperprolactinemia (>700 mU/l), which, nonetheless, was closely associated with a relevant HSD. Both mental disorders and use of medication interfering with sexual function were significantly associated with HSD, as well as depressive and anxiety symptoms. HSD patients showed significantly higher scores in SIEDY scale 2, which explores the relational component of ED. In particular, perceived partner's libido and climax were crucially associated with an impairment of patients' sexual desire. In conclusion, HSD in ED is associated with several biological, psychological, and relational factors that can be simultaneously identified and quantified using the SIEDY structured interview.

Structured interview on erectile dysfunction (SIEDY): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction.

The aim of the present study is the definition of a brief structured interview (SI) providing scores useful for identification and quantification of pathogenetic factors of erectile dysfunction (ED). A SI was developed and applied to a consecutive series of 320 ED patients. A 13-item SI, with three-factor analysis-derived scales, was identified and applied for validation to an independent consecutive series of 194 ED patients. PGE(1) (10 microg) intracavernosal injection, penile duplex ultrasound (PDU), blood hormones, PSA, glycemia, and lipids were used for the assessment of an organic component (OC), and Middlesex Hospital Questionnaire (MHQ) modified for psychological disturbances. Scale 1, dealing with OC, showed a positive correlation with age, BMI, blood pressure, glycemia, and inverse correlation, with testosterone, PGE(1) and several parameters derived from PDU. Scale 2, related to partner's relationship, was not correlated with organic parameters. Scale 3, which measures psychopathological traits was correlated with MHQ scales. Scale 1 (>3) had a sensitivity of 67.9% and a specificity of 67.6% for OC. SIEDY((c)) provides information on ED pathogenesis and might assist physicians in diagnostic and therapeutic choices.

Aging and pathogenesis of erectile dysfunction.

The prevalence and the severity of erectile dysfunction (ED) increase with advancing age; different pathogenetic factors could contribute to age-related ED. We studied organic, relational and intrapsychic components of ED as a function of patients' age in a consecutive series of 977 patients with ED, using the specifically designed structured interview SIEDY. A complete physical examination and a series of biochemical, hormonal, psychometric and penile vascular tests were also performed. Relational factors seems to be more relevant in patients aged over 60 y, while intrapsychic disturbances play a major role in younger subjects. Organic factors are the most important determinant of ED in all age groups, but their contribution is more important in older patients. In fact, basal and dynamic peak cavernosal velocity at Doppler ultrasound penile examination was reduced in older patients. Among hormonal factors, the body mass index-dependent reduction of testosterone in older patients does not seem to play a crucial role in the pathogenesis of ED. No significant correlation was observed between testosterone level and the severity of ED, although patients reporting hypoactive sexual desire showed significantly lower testosterone levels when compared with the rest of the sample. A better understanding of the relative contribution of age-related pathogenetic factors of ED could be of help in the design of appropriate therapeutic approaches.

The therapeutic dilemma: how to use psychotherapy.

Organic, marital and intrapsychic disturbances mutually interact in the pathogenesis of erectile dysfunction (ED). Sexual psychotherapy (SP) should be considered a useful chance on all occasions. When non-organic causes are predominant, SP could help in solving the problem. Conversely, when ED is mainly a symptom of organic diseases, SP should be considered as an important support, reducing the net contribution of marital and/or intrapsychic components and improving responsiveness and compliance to medical treatments. A correct diagnosis is a crucial step in the evaluation of patients reporting ED, in order to quantify the contribution of different pathogenetic factors. Structured Interview on Erectile Dysfunction (SIEDY) is a useful instrument for the first screening of ED patients, providing scores for organic, marital and intrapsychic components. Other instruments, such as body paint or sexuality tree, might also be used to further analyse the problem and to choose the most effective SP intervention for the patient himself or for the couple. In our view, medical and psychosexual therapies are not indeed two distinct therapeutic entities to be used in different clinical settings, but are two important tools to be simultaneously considered (and often simultaneously employed) to fully rescue the sexual satisfaction of the couple.

The impotent couple: low desire.

Hypoactive sexual desire (HSD) is the deficiency of sexual fantasies and desire that should be considered as a disorder if it causes distress to the couple. In the general population, it is the most widespread sexuality-related problem. It is generally accepted that testosterone and prolactin regulate sexual desire. We recently reported that other psychobiological factors associate with HSD in a sample of almost 500 male patients attending our Outpatient Clinic for sexual dysfunction, by using SIEDY structured interview. We now originally extend investigation to a threefold broader patient sample. Considering marital parameters, perceived partner's libido and climax, patient's partner diseases, conflictual or even prolonged couple relationship were all significantly associated with an impairment of patients' sexual desire. Moreover, other lifestyle factors as satisfaction at work and/or domestic inhabitant relationship were significantly correlated to hypoactive sexual desire disorder (HSDD). Among hormonal parameters, severe hyperprolactinaemia (>700 mU/L), although rarely diagnosed (<2.0%), seems to play a greater role than the more common (23%) endocrine disease hypogonadism (testosterone < 12 nm) to the pathogenesis of HSD (RR = 7.5 [2.5-22.4] vs. 1.5 [1.1-1.9], respectively). Both mental disorders and use of medication interfering with sexual function were also significantly associated with HSDD, as well as depressive and anxiety symptoms. Finally, HSD was inversely correlated to sexual and masturbation frequency attempts. In conclusion, HSD is associated with several biological, psychological, and relational factors that can be simultaneously identified and quantified using the SIEDY structured interview.

Psychological diagnosis in sexology.

The author presents a model based on verbal and non-verbal instruments in order to elaborate a psychological diagnosis in troubles of sexual behavior. The instruments usually employed are the following: the map aimed at verifying harmony or conflict with significant people; family drawing, another means to check harmony or conflict in the nuclear family; genogram, in order to reconstruct family myths; body drawing aimed at discovering the body parts that give pleasure, uneasiness, annoyance-tickle and the problems connected with genitals; questionnaire on the couple aimed at finding out areas of mutual dissatisfaction; the drawing of the shared space in the couple, represented by the WE area, in order to identify the relational/emotional deficiencies. Using this model we can simplify the anamnesis, focus on the problematic areas, quickly check the unconscious contents and define a diagnosis with the subsequent hypothesis of intervention.

Organic, relational and psychological factors in erectile dysfunction in men with diabetes mellitus.

INTRODUCTION AND OBJECTIVES: Diabetes mellitus-induced erectile dysfunction (DMED) is thought to be multifactorial in aetiology and to include vascular, neurological, and psychological components. The aim of the present study is to determine the contribution of organic, relational, and intrapsychic components to the pathogenesis of ED in diabetic in comparison with non-diabetic patients. METHODS: We studied a consecutive series of 1027 using SIEDY structured interview. A complete physical examination and a series of metabolic, biochemical, hormonal, psychometric, penile vascular tests and nocturnal penile tumescence and rigidity evaluations were performed. RESULTS: 15% of patient studied were affected by DMED. Diabetic patients with DMED have a greater severity of erectile dysfunction and are more likely to have an organic, rather than an intrapsychic, component. Impaired sexual desire is less frequent in these patients and they had an higher prevalence of hypogonadism than non-diabetic individuals. CONCLUSION: Diabetic patients seeking treatment for erectile dysfunction have a greater severity of disease, less impaired sexual desire, suggesting that the need for medical care in diabetic patients with ED could be even greater than in their non-diabetic counterparts. Considering the higher prevalence of obesity-related decrease of testosterone levels in DMED, an appropriate screening and treatment of hypogonadism might improve the outcome of pharmacotherapy for ED in diabetic patients.

Psycho-biological correlates of rapid ejaculation in patients attending an andrologic unit for sexual dysfunctions.

INTRODUCTION AND OBJECTIVES: Rapid ejaculation (RE) is the most common sexual dysfunction in males. The aim of the present study is to determine the contribution of intrapsychic, organic and relational factors to the pathogenesis of RE and the relationship between RE and erectile dysfunction (ED) in a sample of patients attending for the first time to an Outpatient Clinic for sexual dysfunction. METHODS: We studied a consecutive series of 755 patients using Structured Interview on Erectile Dysfunction (SIEDY), a brief, recently validated, multidimensional instrument specifically designed by our group for the study of pathogenetic factors of ED. RE was defined as ejaculation within 1 minute of vaginal intromission and its severity was categorized on a 4-point scale using a standard question. A complete physical examination and a series of biochemical, hormonal, psychometric, penile vascular and rigidometric evaluations were performed. RESULTS: Twenty-eight percent (n = 214) of patients attending to our sexology clinic reported RE of any degree. Patients reporting RE were younger (48.5 +/- 12.6 vs. 52.9 +/- 12.9 years old for RE and not RE respectively; p < 0.0001) and showed a higher prevalence of anxiety symptoms when compared to the rest of the sample. Among organic factors subjects with RE showed a higher prevalence of hyperthyroidism and significantly lower fasting plasma glucose (94 [87-110] and 98 [89-113] mg/dl for RE and non-RE respectively; p < 0.01). No difference among groups was observed for other hormones or clinical, biochemical and instrumental parameters. Finally RE patients showed a higher prevalence of partial erection sufficient for penetration when compared to the rest of the sample. Similar differences were observed between patients with and without RE when those without ED were excluded from the analysis. CONCLUSION: Our data suggest a minor involvement of organic factors to the pathogenesis of ED in patients with concomitant RE. On the other hand, in our sample, patients complaining about RE are younger, healthier than the rest of the sample and are characterized by high degree of anxiety symptoms and hyperthyroidism.