madman
Super Moderator
ABSTRACT
Background: Premature ejaculation (PE) is present in up to 30% of men with erectile dysfunction (ED). Objectives: To assess the clinical features of men complaining of both ED and PE (ED-PE) as compared to men reporting only ED or PE.
Materials and methods: A consecutive series of 4024 men (mean age 51.2 +/- 13.2 years) consulting for sexual dysfunction was studied. The population was categorized into ED-only (n = 2767; 68.8%), PE-only (n = 475; 1.8%), and ED-PE (n = 782; 19.4%). Sexual symptoms were evaluated using the structured interviews SIEDY and ANDROTEST. Penile color Doppler ultrasound (PDCU) parameters were also assessed.
Results: When compared to PE alone, ED-PE reported more sexual complaints, including impaired morning erections [OR = 5.8 (4.1; 8.3)], decreased sexual desire [OR = 2.6 (1.8; 3.7)], decreased ejaculate volume [OR = 2.7 (1.8; 4.0)], and reduced frequency of sexual intercourse [OR = 1.4 (1.0; 2.0)]. Conversely, ED-PE and ED-only men had a similar prevalence of sexual symptoms. In ED-PE men, the characteristics of ED were similar to ED-only men, whereas the characteristics of PE were milder than in PE-only men. EDPE men had a significantly higher prevalence of hypertension, diabetes, and cardiovascular (CV) diseases [OR = 1.8 (1.1; 3.0), 2.7 (1.3; 5.6) and 2.7 (1.1; 6.5), respectively] than PE-only subjects. Moreover, ED-PE men showed worse dynamic peak systolic velocity at PDCU [B = -12.0 (-17.7;-6.2)] and a greater 10-year estimated CV risk [B = 3.8 (2.5; 5.1)] than PE-only patients. Conversely, comorbidities and PDCU parameters were similar in ED-PE and ED-only men.
Discussion: The present results suggest that men reporting ED and PE should be considered as patients with ED-only, at least at first glance. Consequently, the diagnosis—including the CV risk stratification—and treatment should be primarily focused on the erectile problem.
Conclusions: Erectile dysfunction-PE patients present several similarities with those consulting only for ED, whereas their characteristics are different from PE-only men. In agreement with the guidelines, our results confirm that ED-PE men might be considered (and managed) primarily as patients with ED.
CONCLUSIONS
Among men seeking medical care for sexual dysfunction, the concomitant presence of ED and PE is frequent, with a prevalence of almost 20%. This category of patients is different from those consulting only for PE, since the characteristics of the ejaculatory problem are milder and they report a broader spectrum of concomitant sexual complaints. Conversely, ED-PE patients present several similarities with those consulting only for ED who share the sexual impairments as well as the footprints of CV risk. Recognizing these differences/similarities is important for sexual medicine practitioners because it could help them in deciding the diagnostic and therapeutic work-up. In line with the suggestions of the guidelines (Jannini et al., 2013; McMahon et al., 2013), our study infers that men reporting ED and PE should be primarily considered as patients with an erectile impairment. Consequently, the diagnosis—including the CV risk stratification—and treatment should be primarily focused on the erectile problem and only later on the ELT problem, if not appropriately treated by ED medications.
Background: Premature ejaculation (PE) is present in up to 30% of men with erectile dysfunction (ED). Objectives: To assess the clinical features of men complaining of both ED and PE (ED-PE) as compared to men reporting only ED or PE.
Materials and methods: A consecutive series of 4024 men (mean age 51.2 +/- 13.2 years) consulting for sexual dysfunction was studied. The population was categorized into ED-only (n = 2767; 68.8%), PE-only (n = 475; 1.8%), and ED-PE (n = 782; 19.4%). Sexual symptoms were evaluated using the structured interviews SIEDY and ANDROTEST. Penile color Doppler ultrasound (PDCU) parameters were also assessed.
Results: When compared to PE alone, ED-PE reported more sexual complaints, including impaired morning erections [OR = 5.8 (4.1; 8.3)], decreased sexual desire [OR = 2.6 (1.8; 3.7)], decreased ejaculate volume [OR = 2.7 (1.8; 4.0)], and reduced frequency of sexual intercourse [OR = 1.4 (1.0; 2.0)]. Conversely, ED-PE and ED-only men had a similar prevalence of sexual symptoms. In ED-PE men, the characteristics of ED were similar to ED-only men, whereas the characteristics of PE were milder than in PE-only men. EDPE men had a significantly higher prevalence of hypertension, diabetes, and cardiovascular (CV) diseases [OR = 1.8 (1.1; 3.0), 2.7 (1.3; 5.6) and 2.7 (1.1; 6.5), respectively] than PE-only subjects. Moreover, ED-PE men showed worse dynamic peak systolic velocity at PDCU [B = -12.0 (-17.7;-6.2)] and a greater 10-year estimated CV risk [B = 3.8 (2.5; 5.1)] than PE-only patients. Conversely, comorbidities and PDCU parameters were similar in ED-PE and ED-only men.
Discussion: The present results suggest that men reporting ED and PE should be considered as patients with ED-only, at least at first glance. Consequently, the diagnosis—including the CV risk stratification—and treatment should be primarily focused on the erectile problem.
Conclusions: Erectile dysfunction-PE patients present several similarities with those consulting only for ED, whereas their characteristics are different from PE-only men. In agreement with the guidelines, our results confirm that ED-PE men might be considered (and managed) primarily as patients with ED.
CONCLUSIONS
Among men seeking medical care for sexual dysfunction, the concomitant presence of ED and PE is frequent, with a prevalence of almost 20%. This category of patients is different from those consulting only for PE, since the characteristics of the ejaculatory problem are milder and they report a broader spectrum of concomitant sexual complaints. Conversely, ED-PE patients present several similarities with those consulting only for ED who share the sexual impairments as well as the footprints of CV risk. Recognizing these differences/similarities is important for sexual medicine practitioners because it could help them in deciding the diagnostic and therapeutic work-up. In line with the suggestions of the guidelines (Jannini et al., 2013; McMahon et al., 2013), our study infers that men reporting ED and PE should be primarily considered as patients with an erectile impairment. Consequently, the diagnosis—including the CV risk stratification—and treatment should be primarily focused on the erectile problem and only later on the ELT problem, if not appropriately treated by ED medications.
