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8 pages, 377 KiB

Open AccessArticle

Estradiol–Testosterone Imbalance Is Associated with Erectile Dysfunction in Patients with Klinefelter Syndrome

by Maurizio De Rocco Ponce, Riccardo Selice, Antonella Di Mambro, Luca De Toni, Carlo Foresta and Andrea Garolla

J. Clin. Med. 2021, 10(11), 2319; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112319 - 26 May 2021

Cited by 1 | Viewed by 3026

Abstract

Erectile dysfunction (ED) is a frequent sexual disorder in adult men. Klinefelter syndrome (KS) is the most common sex chromosomal disorder and a frequent cause of male hypogonadism. Psychological and cognitive aspects are quite typical in KS and have been linked to ED, [...] Read more.

Erectile dysfunction (ED) is a frequent sexual disorder in adult men. Klinefelter syndrome (KS) is the most common sex chromosomal disorder and a frequent cause of male hypogonadism. Psychological and cognitive aspects are quite typical in KS and have been linked to ED, while the role of testosterone (T) levels in sexual function of KS subjects has not been fully elucidated. The purpose of the present study is to investigate the role of hormonal disturbances in erectile function of subjects with KS. We conducted a retrospective study involving 52 Klinefelter patients newly diagnosed who never received androgen replacing therapy. All the subjects underwent medical history, accurate physical examination, and blood tests. The International Index of Erectile Function questionnaire (IIEF-EF) score correlated negatively with estradiol/testosterone ratio (E2/T); this correlation remained statistically significant after correction for age (ρ −0.320 p = 0.018). A multiple linear regression analysis identified age and E2/T as the main predictors of IIEF-EF score (R2 0.169 F = 3.848 p = 0.008). Our findings corroborate previous KS data obtained in the general population showing an association between higher E2/T ratio and impaired erectile function. Larger studies are required to better elucidate the pathophysiology of ED in patients with KS. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

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9 pages, 369 KiB

Open AccessArticle

Erectile Dysfunction Is the Main Correlate of Depression in Men with Chronic Spinal Cord Injury

by Arcangelo Barbonetti, Settimio D’Andrea, Chiara Castellini, Maria Totaro, Mario Muselli, Francesca Cavallo, Giorgio Felzani, Stefano Necozione and Sandro Francavilla

J. Clin. Med. 2021, 10(10), 2090; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10102090 - 13 May 2021

Cited by 6 | Viewed by 1985

Abstract

Depression is the most prevalent psychological issue after a spinal cord injury (SCI) and is associated with noticeable disability, mortality and health expenditure. As SCI mainly occurs in sexually active men at a young age, and can lead to them suffering from an [...] Read more.

Depression is the most prevalent psychological issue after a spinal cord injury (SCI) and is associated with noticeable disability, mortality and health expenditure. As SCI mainly occurs in sexually active men at a young age, and can lead to them suffering from an organic neurogenic erectile dysfunction (ED), we supposed that ED could be a major correlate of depressive status in men with SCI. As documented by a Beck Depression Inventory-II (BDI-II) score ≥14, depression was reported in 17 out of 57 men with a chronic SCI (29.8%). They exhibited a significantly higher prevalence of ED and a more severe bowel and bladder dysfunction when compared to the group without depression. At the multiple logistic regression analysis, depression showed a significant independent association with ED (OR = 19.0, 95% CI: 3.1, 203.3; p = 0.004) and, to a lesser extent, with a severe impairment of bowel and bladder function (OR = 0.84; 95% CI: 0.72, 0.94; p = 0.01). Depression was observed in 43.7% of men with ED and only in 12.0% of those without ED (p = 0.002). In conclusion, healthcare providers should give the right level of importance to the management of ED in men with SCI, as this represents a major independent correlate of depression, which, in turn, might hinder physical rehabilitation and exacerbate physical health issues related to SCI. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

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Review

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12 pages, 312 KiB

Open AccessReview

Erectile Dysfunction in Men with Chronic Obstructive Pulmonary Disease

by Lorenzo Marinelli, Fabio Lanfranco, Giovanna Motta and Marco Zavattaro

J. Clin. Med. 2021, 10(12), 2730; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10122730 - 21 Jun 2021

Cited by 9 | Viewed by 3449

Abstract

Erectile dysfunction (ED) seems to be a widespread sexual issue in men affected by chronic obstructive pulmonary disease (COPD). Multiple causes appear to be involved such as hormonal imbalance, smoking habit, chronic inflammation, endothelial dysfunction, chronic hypoxia, psychiatric disorders (depression and anxiety), and [...] Read more.

Erectile dysfunction (ED) seems to be a widespread sexual issue in men affected by chronic obstructive pulmonary disease (COPD). Multiple causes appear to be involved such as hormonal imbalance, smoking habit, chronic inflammation, endothelial dysfunction, chronic hypoxia, psychiatric disorders (depression and anxiety), and medications. ED can have a significant impact on COPD men and consequently on their quality of life, which is usually already compromised. Given this situation, however, pneumologists usually do not properly care for the sexuality of COPD patients especially because men can be reluctant to talk about their intimate issues. The aim of this narrative review is to briefly summarize the evidence emerging from literature and to provide a wide point of view about sexual dysfunction in COPD men. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

12 pages, 975 KiB

Open AccessReview

Hypothalamic–Pituitary Diseases and Erectile Dysfunction

by Gianmaria Salvio, Marianna Martino, Giulia Giancola, Giorgio Arnaldi and Giancarlo Balercia

J. Clin. Med. 2021, 10(12), 2551; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10122551 - 09 Jun 2021

Cited by 13 | Viewed by 3835

Abstract

Several hormones contribute to ensure penile erection, a neurovascular phenomenon in which nitric oxide plays a major role. Erectile dysfunction (ED), which is defined as the persistent inability to obtain or maintain penile erection sufficient for a satisfactory sexual performance, may be due [...] Read more.

Several hormones contribute to ensure penile erection, a neurovascular phenomenon in which nitric oxide plays a major role. Erectile dysfunction (ED), which is defined as the persistent inability to obtain or maintain penile erection sufficient for a satisfactory sexual performance, may be due to arteriogenic, neurogenic, iatrogenic, but also endocrinological causes. The hypothalamus–pituitary axis plays a central role in the endocrine system and represents a fundamental link between the brain and peripheral glands, including gonads. Therefore, the hormonal production of the hypothalamic–pituitary axis can control various aspects of sexual function and its dysregulation can compromise erectile function. In addition, excess and deficiency of pituitary hormones or metabolic alterations that are associated with some pituitary diseases (e.g., Cushing’s disease and acromegaly, hypopituitarism) can determine the development of ED with different mechanisms. Thus, the present review aimed to explore the relationship between hypothalamic and pituitary diseases based on the most recent clinical and experimental evidence. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

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22 pages, 997 KiB

Open AccessReview

Role of Glucose-Lowering Medications in Erectile Dysfunction

by Angelo Cignarelli, Valentina Annamaria Genchi, Rossella D’Oria, Fiorella Giordano, Irene Caruso, Sebastio Perrini, Annalisa Natalicchio, Luigi Laviola and Francesco Giorgino

J. Clin. Med. 2021, 10(11), 2501; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112501 - 05 Jun 2021

Cited by 12 | Viewed by 5543

Abstract

Erectile dysfunction (ED) is a long-term complication of type 2 diabetes (T2D) widely known to affect the quality of life. Several aspects of altered metabolism in individuals with T2D may help to compromise the penile vasculature structure and functions, thus exacerbating the imbalance [...] Read more.

Erectile dysfunction (ED) is a long-term complication of type 2 diabetes (T2D) widely known to affect the quality of life. Several aspects of altered metabolism in individuals with T2D may help to compromise the penile vasculature structure and functions, thus exacerbating the imbalance between smooth muscle contractility and relaxation. Among these, advanced glycation end-products and reactive oxygen species derived from a hyperglycaemic state are known to accelerate endothelial dysfunction by lowering nitric oxide bioavailability, the essential stimulus of relaxation. Although several studies have explained the pathogenetic mechanisms involved in the generation of erectile failure, few studies to date have described the efficacy of glucose-lowering medications in the restoration of normal sexual activity. Herein, we will present current knowledge about the main starters of the pathophysiology of diabetic ED and explore the role of different anti-diabetes therapies in the potential remission of ED, highlighting specific pathways whose activation or inhibition could be fundamental for sexual care in a diabetes setting. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

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21 pages, 630 KiB

Open AccessFeature PaperReview

Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men’s Health?

by Dimitri Yannas, Francesca Frizza, Linda Vignozzi, Giovanni Corona, Mario Maggi and Giulia Rastrelli

J. Clin. Med. 2021, 10(10), 2221; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10102221 - 20 May 2021

Cited by 17 | Viewed by 3841

Abstract

Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). Traditional risk factors are not found in all [...] Read more.

Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). Traditional risk factors are not found in all subjects at high CV risk. In fact, a relevant proportion of MACE occurs in men who are apparently risk factor free. In men with ED, it is important to take into account not only traditional risk factors but also unconventional ones. Several parameters that derive from good clinical assessment of subjects with ED have proven to be valuable predictors of MACE. These include family history of cardiometabolic events, alcohol abuse, fatherhood, decreased partner’s sexual interest, severe impairment in erection during intercourse or during masturbation, impaired fasting glucose, increased triglycerides, obesity even without metabolic complications, decreased penile blood flows or impaired response to an intra-cavernosal injection test. Recognizing these risk factors may help in identifying, among subjects with ED, those who merit stricter lifestyle or pharmacological interventions to minimize their CV risk. Effective correction of risk factors in ED men considered as high risk, besides reducing CV risk, is also able to improve erectile function. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

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25 pages, 1550 KiB

Open AccessReview

HIV and Sexual Dysfunction in Men

by Sara De Vincentis, Giulia Tartaro, Vincenzo Rochira and Daniele Santi

J. Clin. Med. 2021, 10(5), 1088; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10051088 - 05 Mar 2021

Cited by 21 | Viewed by 3912

Abstract

Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men [...] Read more.

Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress and stigma), alongside classical factors non-related to HIV, should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

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14 pages, 283 KiB

Open AccessReview

Mean Platelet Volume as a Marker of Vasculogenic Erectile Dysfunction and Future Cardiovascular Risk

by Andrea Crafa, Rosita A. Condorelli, Laura M. Mongioì, Rossella Cannarella, Federica Barbagallo, Antonio Aversa, Giulia Izzo, Anna Perri, Aldo E. Calogero and Sandro La Vignera

J. Clin. Med. 2020, 9(8), 2513; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9082513 - 04 Aug 2020

Cited by 11 | Viewed by 4825

Abstract

Cardiovascular diseases are the main cause of mortality in the Western population, so the attempt to find a marker capable of predicting their early onset is not surprising. It is known that arteriogenic erectile dysfunction (ED) precedes the onset of a major coronary [...] Read more.

Cardiovascular diseases are the main cause of mortality in the Western population, so the attempt to find a marker capable of predicting their early onset is not surprising. It is known that arteriogenic erectile dysfunction (ED) precedes the onset of a major coronary event by several years. However, a marker that is able to early identify those patients who should undergo further diagnostic investigations is, to date, missing. Recent research on this topic has focused on the role of the mean platelet volume (MPV), a marker of platelet activity that is high in most vascular diseases, such as coronary artery disease (CAD), stroke, peripheral artery disease (PAD), and ED. The basic pathophysiological mechanism of all these clinical conditions is atherosclerosis. Platelets play a central role in amplifying this process both indirectly by stimulating endothelial cells to produce inflammatory cytokines and chemokines, and directly through the expression of membrane receptors and the release of molecules that contribute to the formation of atherosclerotic plaque. The objective of this review is to critically analyze the evidence on the role of MPV in predicting the diagnosis and severity of vasculogenic ED and the possibility of using this simple marker as a first step to start a diagnostic process aimed at assessing the cardiovascular risk in these patients. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

14 pages, 303 KiB

Open AccessReview

Erectile Dysfunction after Kidney Transplantation

by Anna Perri, Giulia Izzo, Danilo Lofaro, Sandro La Vignera, Antonio Brunetti, Aldo Eugenio Calogero and Antonio Aversa

J. Clin. Med. 2020, 9(6), 1991; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9061991 - 25 Jun 2020

Cited by 14 | Viewed by 5247

Abstract

Patients with kidney transplantation often have a worse quality of life than the general population. One of the reasons for this, in male patients, is the high prevalence of erectile dysfunction. This is mainly due to the presence of comorbidities, surgery for kidney [...] Read more.

Patients with kidney transplantation often have a worse quality of life than the general population. One of the reasons for this, in male patients, is the high prevalence of erectile dysfunction. This is mainly due to the presence of comorbidities, surgery for kidney transplantation, adverse drug effects, psychological changes related to chronic disease, as well as hyperprolactinemia and hypogonadism. Whenever these endocrine dysfunctions occur after kidney transplantation, they must be corrected with appropriate treatment, i.e., testosterone replacement therapy. Administration of the phosphodiesterase-5 inhibitor (PDE5i) sildenafil at the recommended posology does not significantly alter the pharmacokinetics of the calcineurin inhibitors cyclosporin A or tacrolimus and does not impair kidney allograft function. Tacrolimus increases the peak concentration and prolongs the half-life of PDE5i in kidney transplant patients and, therefore, daily administration cannot be recommended due to the significant drop in blood pressure. Intracavernous injection or topical application of alprostadil can be a second-line option for the treatment of erectile dysfunction after kidney transplantation, which does not alter cyclosporine concentrations and does not deteriorate kidney function. Finally, penile prostheses can be successfully implanted following pelvic organ transplantation after eliminating the risk of infection associated with surgery. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

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