bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tadalafil Is Efficacious and Well Tolerated in the Treatment of Erectile Dysfunction (ED) in Men over 65 Years of Age: Results from Multiple Observations in Men with ED in National Tadalafil Study in the United States
Authors: Sharlip Ira D. , Shumaker Bryan P. , Hakim Lawrence S. , Goldfischer Evan , Natanegara Fanni , Wong David G. 
Published: February 2008

ABSTRACT

Introduction
Erectile dysfunction is increasingly common with advancing age, yet sexual activity and intimacy are important to elderly men.

Aim
To assess the efficacy and tolerability of tadalafil in men over the age of 65 years.

Method
In this multicenter open-label study, 188 men (mean age=71.6 years) who were over age 65 and did not have diabetes mellitus or clinical depression received tadalafil 20 mg, taken on demand, for up to 12 weeks.

Main Outcome Measures
Efficacy was assessed using the International Index of Erectile Function (IIEF) and Sexual Encounter Profile (SEP). Psychosocial outcomes were evaluated using the Psychological and Interpersonal Relationship Scale (PAIRS).

Results
Tadalafil treatment significantly improved all domains of the IIEF from baseline, including the erectile function (EF) domain (change=8.8, end point=21.6; P &lt;0.001). Mean per-patient percentage of “yes” responses to SEP questions concerning successful penetration (SEP2; change=33.5%, end point=73.5%; P &lt;0.001) and successful intercourse (SEP3; change=39.6%, end point=59.6%; P &lt;0.001) also improved significantly from baseline. Forty percent of the patients with baseline EF scores &lt;26 had normal EF (IIEF-EF domain scores ≥26) at end point, and 81% reported improved erections in the Global Assessment Questionnaire. At least 56% of attempts at sexual intercourse were successfully completed (SEP3) at all time intervals up to 36 hours after tadalafil administration. The patients also experienced significant improvement in both the sexual self-confidence and spontaneity domains of the PAIRS. Tadalafil was well tolerated, with &lt;5% of the patients discontinuing because of adverse events.

Conclusion
Tadalafil 20 mg was effective and well tolerated in elderly men with ED.
The Effect of Physician and Patient Education When Combined with Vardenafil Treatment in Canadian Males with Erectile Dysfunction: An Open-Label, Factorial-Designed, Cluster-Randomized Clinical Trial
Authors: Brock Gerald , Carrier Serge , Alarie Pierre , Pommerville Peter , Casey Richard , Harris Stewart , Ward Richard 
Published: February 2008

ABSTRACT

Introduction
Studies evaluating the effect of education on treatment success with phosphodiesterase type 5 (PDE5) inhibitor therapy in men with erectile dysfunction (ED) are limited. Additional education of the primary care physician (PCP) and the patient are thought to optimize the treatment of ED.

Aim
To assess the impact of education of the PCP or of the patient in the treatment of ED with vardenafil relative to usual care.

Methods
In this 12-week, open-label, multicenter, factorial-designed, cluster-randomized Canadian study, 1,029 patients with ED were enrolled into four different education groups: usual care, patient education, PCP education, and both PCP and patient education. All groups started on vardenafil 10 mg, with the option to titrate at weeks 4 and 8.

Main Outcome Measures
The primary efficacy measure was the difference at week 4 last observation carried forward (LOCF) in the overall improvement in erectile function (EF) as measured by the Global Assessment Question (GAQ), while on background vardenafil, between those receiving education vs. those who did not. Other secondary assessments included responses to diary questions regarding penetration (sexual encounter profile, SEP2) and erection maintenance (SEP3), and to questionnaires regarding treatment satisfaction (Erectile Dysfunction Inventory of Treatment Satisfaction [EDITS]).

Results
A total of 956 patients were included in the intent-to-treat population. Mean baseline International Index of Erectile Function-EF domain score was 13. GAQ response rates at week 4 LOCF were high (&gt;80%) for all groups, regardless of the education given. Mean per patient SEP2 and SEP3 rates at week 12 LOCF were 86–89% and 79–83%, respectively. In an exploratory analysis, a positive relationship between GAQ responses and EDITS scores was observed (P  ≤ 0.0007). Vardenafil was generally well tolerated.

Conclusions
In men with moderate ED, vardenafil led to high success rates and satisfaction regardless of the education given. The benefits of education for PCP and patients in Canada were possibly masked by a ceiling effect in this study population.
Brain Activation Areas of Sexual Arousal with Olfactory Stimulation in Men: A Preliminary Study Using Functional MRI
Authors: Huh Joon , Park Kwangsung , Hwang In Sang , Jung Seung Il , Kim Hyeong-Jung , Chung Tae-Woong , Jeong Gwang-Woo 
Published: February 2008

ABSTRACT

Introduction
There have been extensive studies evaluating the functional neuroanatomy of the brain during visual sexual stimulation. However, little data exist concerning the role of olfactory stimulation in human sexuality.

Aim
This preliminary study intended to elucidate the brain areas responding to an olfactory sexual stimulus using functional magnetic resonance imaging (fMRI).

Methods
Eight healthy right-handed heterosexual male volunteers (20–35 years of age), having normal olfaction and no brain diseases, were recruited. During fMRI, a women's perfume was given as an olfactory sexual stimulant in an alternating block design with a 30-second stimulation period followed by a 30-second rest. After the fMRI sessions, the participants provided ratings for both the odorant's intensity and perceived arousal.

Main Outcome Measures
The study subjects rated the odorant stimulation and perceived sexual arousal response by Likert-type rating scales. Brain activation maps were made by blood oxygenation level-dependent (BOLD)-based fMRI with an echo-planar imaging pulse sequence.

Results
Two out of eight subjects experienced “strong” sexual arousal, and three subjects experienced “moderate” arousal during olfactory stimulation, resulting in a mean score of 2.25 on a 4-point scale. The common brain areas activated in response to the odor stimulus in all eight subjects included the insula, the inferior and middle frontal gyrus, and the hypothalamus. The median cingulate gyrus, thalamus, angular gyrus, lingual gyrus, and cerebellar cortex were activated in subjects who had moderate or strong sexual arousal response.

Conclusion
Olfactory stimulation with women's perfume produces the activation of specific brain areas in men. The brain areas activated differed according to the degree of perceived sexual arousal response. Further studies are needed to elucidate brain activation response according to the different kinds and intensities of olfactory stimulation.
Tibolone and Transdermal E2/NETA for the Treatment of Female Sexual Dysfunction in Naturally Menopausal Women: Results of a Randomized Active-Controlled Trial
Authors: Nijland Esme A. , Schultz Willibrord C.M. Weijmar , Nathorst-Boös Jörgen , Helmond Frans A. , Van Lunsen Rik H.W. , Palacios Santiago , Norman Robert J. , Mulder Roel J. , Davis Susan R. ,   LISA study investigators
Published: February 2008

ABSTRACT

Introduction
There are some data to suggest that tibolone improves sexual function in postmenopausal women. However, evidence about the effects of tibolone on female sexual dysfunction is lacking.

Aim
To compare the efficacy on sexual function of tibolone 2.5 mg to continuous combined transdermal estradiol (E2)/norethisterone acetate (NETA) (50 µg/140 µg) in naturally postmenopausal women with sexual dysfunction.

Main Outcome Measure
Differences between treatment groups in the change from baseline for the composite subscore of the arousal, desire, and satisfaction domains of the self-reported Female Sexual Function Index (FSFI).

Methods
A multicenter, double-blind, randomized, clinical trial was performed. Sexual function was assessed with the FSFI at baseline, week 12, and week 24. The outcomes of the Female Sexual Distress Scale (FSDS) and the frequency of satisfying sexual events (daily diaries) were secondary end points.

Results
Four hundred three women, mean age 56, were included. Both therapies improved sexual function assessed by the FSFI. In the per protocol analysis, but not in the intent-to-treat analysis, the increase in FSFI scores was significantly larger in the tibolone group when compared with the E2/NETA patch group at week 24 (P  = 0.036 and P =0.025 for the composite subscore and total FSFI score, respectively). The satisfying sexual event rate increased from three to four times per 28 days at week 24 (P &lt;0.001 from baseline for both groups), with no difference between groups. The FSDS showed a significant decrease from baseline (P &lt;0.001), which was comparable for both treatment groups.

Conclusions
Both treatments resulted to improved overall sexual function, as determined by scores on the FSFI, an increase in the frequency of sexual events, and a reduction in sexuality-related personal distress. The statistically significant higher FSFI scores in the tibolone group, when compared to the E2/NETA group, may be because of tibolone's combined estrogenic and androgenic properties.
The Effect of Hyperbaric Oxygen Therapy on Erectile Function Recovery in a Rat Cavernous Nerve Injury Model
Authors: Müller Alexander , Tal Raanan , Donohue John F. , Akin-Olugbade Yemi , Kobylarz Keith , Paduch Darius , Cutter Suzanne C. , Mehrara Babak J. , Scardino Peter T. , Mulhall John P. 
Published: February 2008

ABSTRACT

Introduction
Cavernosal oxygenation appears to be important for preservation of erectile tissue health. Hyperbaric oxygen therapy (HBOT) has been shown to improve tissue oxygenation and has neuromodulatory effects.

Aim
This study was designed to define the effects of HBOT on erectile function (EF) and cavernosal tissue in the rat cavernous nerve (CN) injury model.

Methods
Four groups of Sprague-Dawley rats were studied: rats with bilateral CN crush, HBOT treated (Crush+/HBOT+); bilateral CN-crush/no HBOT (C+/H−); no crush/no HBOT (C−/H−); and no crush/HBOT (C−/H+). HBOT was delivered daily for 90 minutes at three atmospheres for 10 days commencing the day of CN crush.

Main Outcome Measures
Ten days after CN injury, the animals underwent CN stimulation measuring the maximal intracavernosal pressure/mean arterial pressure (ICP/MAP) ratios. Corporal tissue was harvested pre-sacrifice, and immunohistochemically stained for nerve growth factor (NGF), endothelial nitric oxide synthase (eNOS), and cluster of differentiation molecule (CD31). Histologic analysis was performed for Masson's trichrome to assess the smooth muscle–collagen ratio. Terminal deoxynucleotidyl transferase Biotin-dUTP Nick End Labeling assay was used to define apoptotic indices (AIs).

Results
The C+/H− group had significantly lower ICP/MAP ratios compared with C−/H− rats, (31% vs. 70%, P &lt;0.001). C+/H+ rats had significantly higher ICP/MAP ratio recovery compared with the C+/H− group (55% vs. 31%, P =0.005). NGF and eNOS staining densities were higher in C+/H+ rats compared with C+/H− rats (P &lt;0.05 and P &lt;0.001, respectively). No difference was seen in CD31 expression. Staining density for MT displayed a trend toward higher smooth muscle preservation after HBOT. AIs were significantly increased by HBOT (P &lt;0.05).

Conclusion
HBOT following a CN injury improved EF preservation in this model, supporting the cavernosal oxygenation concept as protective mechanism for EF. The effects appear to be mediated via preservation of neurotrophic and endothelial factor expression.
Low-Fat Diet and Exercise Preserve eNOS Regulation and Endothelial Function in the Penis of Early Atherosclerotic Pigs: A Molecular Analysis
Authors: Musicki Biljana , Liu Tongyun , Strong Travis , Jin Liming , Laughlin M. Harold , Turk James R. , Burnett Arthur L. 
Published: February 2008

ABSTRACT

Introduction
Diet and exercise affect endothelial function in the penis, but the molecular mechanisms underlying their effects are not understood.

Aims
We evaluated endothelial nitric oxide synthase (eNOS) interaction with its negative regulator caveolin-1 and eNOS uncoupling as molecular targets in the penis associated with the beneficial effects of low-fat diet and chronic exercise.

Methods
The penes were obtained from adult male Yucatan pigs fed a normal-fat or high-fat diet on exercised or sedentary regimen for 24 weeks. Markers of endothelial function (guanosine 3′,5′-monophosphate [cGMP] production), endothelial dysfunction (eNOS uncoupling and eNOS interaction with caveolin-1), and oxidative stress (thiobarbituric acid reactive substances [TBARS]) were measured in the penes. The concentrations of cGMP and TBARS were determined using commercial kits. eNOS uncoupling was determined by low-temperature sodium dodecyl sulfate polyacrylamide gel electrophoresis. eNOS binding to caveolin-1, eNOS phosphorylation (Ser-1177), and protein expression of eNOS and caveolin-1 were measured by Western blot analysis in penes purified for NOS and in homogenates, respectively.

Main Outcome Measures
Molecular parameters of endothelial function including eNOS regulatory function.

Results
Relative to normal-fat diet, high-fat diet significantly (P &lt;0.05) reduced cGMP levels and significantly (P &lt;0.05) increased eNOS uncoupling, eNOS binding to caveolin-1, and TBARS production in the penis of sedentary pigs. Exercise of pigs on high-fat diet reversed (P &lt;0.05) the abnormalities in cGMP levels, eNOS uncoupling, and eNOS binding to caveolin-1, but not TBARS levels. Exercise of pigs on normal-fat diet did not affect any of these parameters. Protein expressions of caveolin-1, phosphorylated (Ser-1177), and total eNOS were unaffected by diet or exercise.

Conclusion
Low-fat diet and chronic exercise preserve endothelial function in the pig penis by sustaining active eNOS in its dimeric form and by limiting eNOS interaction with its negative regulator caveolin-1.
NADPH Oxidase Activation: A Mechanism of Hypertension-Associated Erectile Dysfunction
Authors: Jin Liming , Lagoda Gwen , Leite Romulo , Webb R. Clinton , Burnett Arthur L. 
Published: February 2008

ABSTRACT

Introduction
Hypertension is a risk factor for erectile dysfunction (ED). The pathophysiologic basis of ED in hypertension remains largely unknown.

Aim
The goal of this study was to test the hypothesis that increased nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity contributes to the development of hypertension-associated ED.

Methods
Male Sprague-Dawley rats were implanted with osmotic pumps containing saline or angiotensin II (Ang II, 70 ng/min) for 28 days and treated with or without the NADPH oxidase inhibitor apocynin (10 mM) in the drinking water.

Main Outcome Measures
Erectile function was examined by measuring the mean arterial blood pressure (MAP) and intracavernosal pressure (ICP) upon electrical stimulation of the cavernous nerve. Protein expression levels of NADPH oxidase subunits were analyzed by Western blot. Reactive oxygen species production was determined by dihydroethidium (DHE) staining and thiobarbituric acid reactive substances (TBARS) assay.

Results
Maximum ICP (MaxICP) and ICP area under the curve, which were normalized by MAP, were significantly reduced in Ang II-infused hypertensive rats compared to that of normotensive rats (P &lt;0.05). Protein expression of NADPH oxidase subunit p47phox was significantly increased by 30% in Ang II-infused hypertensive rat penes along with increased DHE staining and TBARS levels (P &lt;0.05) when compared to that of controls. There were no significant changes in p67phox or gp91phox protein expression. Apocynin reduced NADPH oxidase protein expression and TBARS levels as well as improved MaxICP and ICP area under curve in Ang II-infused hypertensive rats (P &lt;0.05).

Conclusions
These data suggest that activation of NADPH oxidase is a molecular mechanism for hypertension-associated ED. Apocynin treatment exerted protective effects on erectile function through inhibition of NADPH oxidase activity, thereby reducing oxidative stress in Ang II-infused hypertensive rats. This is the first study to identify the importance of NADPH oxidase in the regulation of erectile function in vivo.
The Association between Sexual Function, Pain, and Psychological Adaptation of Men Diagnosed with Chronic Pelvic Pain Syndrome Type III
Authors: Aubin Sylvie , Berger Richard E. , Heiman Julia R. , Ciol Marcia A. 
Published: February 2008

ABSTRACT

Introduction
Prostatitis/chronic pelvic pain syndrome (CPPS) is known to have a negative impact on quality of life, especially on intimate relationships and sexual function. Information is, however, missing on the contribution of demographic and psychological variables to sexual variables.

Aim
We compared the sexual function of men with CPPS to men without pain, and examined the relationship between the sexual, demographic, and psychological measures in men with CPPS.

Main Outcome Measures
Self-report questionnaires assessing demographic, pain, sexual function, and psychological adaptation.

Methods
The sample consisted of 72 men diagnosed with CPPS and 98 men without any pain condition. Self-report questionnaires measuring demographic, pain, and sexual function were completed once at the eligibility visit by all subjects. CPPS subjects completed additional questionnaires related to pain and psychological adaptation.

Results
CPPS subjects differed from controls by reporting significantly less frequent sexual desire or thoughts, less frequent sexual activities, less arousal/erectile function, less orgasm function, and higher frequencies of genital pain during/after intercourse. When we adjusted for age and marital status, the difference between groups remained for thoughts/desire, frequency of sexual activity, and arousal/erectile function. Analysis of factors related to sexual function in CPPS subjects included pain status and psychological adaptation. Results showed that frequency of sexual activity decreased with increasing depression, whereas arousal/erectile function decreased with increasing pain symptoms and stress appraisal. Orgasm function decreased with increasing depression and pleasure/satisfaction decreased with increasing pain symptoms, stress appraisal, and decreasing belief of a relationship between emotions and pain.

Conclusions
We found a differential sexual profile for men with CPPS when compared to men without pain. The results suggest that interventions addressing psychological factors affecting sexual responses should be further studied in prospective clinical trials as one possible way to improve sexual function and satisfaction in men with CPPS.
Age of First Sexual Intercourse and Acculturation: Effects on Adult Sexual Responding
Authors: Woo Jane S.T. , Brotto Lori A. 
Published: February 2008

ABSTRACT

Introduction
Although age of first intercourse and the emotional aspects of that experience are often a target in assessment because they are thought to contribute to later sexual functioning, research to date on how sexual debut relates to adult sexual functioning has been limited and contradictory.

Aim
The goal of this study was to explore the association between age of first intercourse and adult sexual function in a sample of Euro-Canadian and Asian Canadian university students. In addition, culture-based comparisons of sexual complaints were made to clarify the role of culture in sexual response.

Methods
Euro-Canadian (N=299) and Asian Canadian (N=329) university students completed the Golombok-Rust Inventory of Sexual Satisfaction and the Vancouver Index of Acculturation.

Main Outcome Measures
Self-reported sexual problems and bidimensional acculturation.

Results
Ethnic group comparisons revealed that Asians reported more sexual complaints including sexual avoidance, dissatisfaction and non-sensuality. Among the women, Asians reported higher scores on the Vaginismus and Anorgasmia subscales whereas the ethnic groups did not differ on the male-specific measures of sexual complaints. In the overall sample, older age of first intercourse was associated with more sexual problems as an adult, including more sexual infrequency, sexual avoidance, and non-sensuality. Among the Asian Canadians, less identification with Western culture was predictive of more sexual complaints overall, more sexual noncommunication, more sexual avoidance, and more non-sensuality. For Asian women, acculturation interacted with age of first intercourse to predict Vaginismus scores.

Conclusions
Overall, these data replicate prior research that found that a university sample of individuals of Asian descent have higher rates of sexual problems and that this effect can be explained by acculturation. Earlier sexual debut was associated with fewer sexual complaints in adulthood.
Does Management of Erectile Dysfunction after Radical Prostatectomy Meet Patients' Expectations? Results of a National Survey (REPAIR) by the French Urological Association
Authors: Chartier-Kastler Emmanuel , Amar Edouard , Chevallier Daniel , Montaigne Olivier , Coulange Christian , Joubert Jean-Michel , Giuliano François 
Published: February 2008

ABSTRACT

Introduction
Little stress has been placed on patients' satisfaction with regard to management of erectile dysfunction (ED) after radical prostatectomy (RP) and on how physicians' and patients' views may differ in this respect.

Aim
To assess the extent to which urologists' perceptions of their patients' expectations and the actual needs expressed by these patients coincide with regard to ED and its management.

Methods
Those French urologists who provisionally accepted to participate in the survey (760/1,272; 59.7%) received a physician survey instrument, 10 patient data forms to be completed during the first 10 consultations of patients who had undergone RP less than 12 months previously, and 10 copies of a questionnaire for patients to complete.

Main Outcome Measures
Patient-reported sexual activity, satisfaction with sexual activity (Male Sexual Health Questionnaire), and treatment expectations; urologists' subjective assessment of the importance given by their patients to ED; the timing they propose for starting ED treatment.

Results
Overall, 535/1,272 urologists (42%) returned the physician survey instrument (45.6 ± 8.7 years, 28–67) and 2,644 patients completed the patient questionnaire (64.0 ± 6.1 years, 44–79). The percentage of patients having intercourse pre RP was highly age-dependent (89% at 55–59 years; 56% at ≥70 years); 70–75% of patients claimed to be satisfied with their pre-RP sexual activity. Post RP, 27–53% of patients (depending upon length of follow-up), who were sexually active pre RP, had intercourse. Only 18% (&lt;5 months' follow-up) or 28% (&gt;5 months' follow-up) were satisfied. Over half (53%)—and especially the younger patients—expected early ED treatment (1 or 3 months post RP). Agreement between patients' expectations and urologists beliefs on timing of ED treatment was poor. At the 1- or 2-month visits, 73% of patients were already finding ED frustrating.

Conclusions
Erectile dysfunction is an important issue for patients who have undergone RP. Urologists tend to underestimate patients' distress and desire for early treatment.