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The Challenge of Erectile Dysfunction Management in the Young Man

Current Urology Reports volume 16, Article number: 84 (2015) Cite this article

Abstract

Erectile dysfunction (ED) in a young man is an important health problem that significantly impacts the patient’s quality of life and can have a detrimental effect on his well-being and relationship with his partner. Erectile dysfunction or impotence is one of the few disorders that will bring a young man into the doctor’s office. This review article focuses on the epidemiology, etiology, presentation, work-up, and treatment of young men (age ~20–40 years old) presenting with complaints of ED. It is important to identify the precise etiology of the ED before proceeding with further evaluation and treatment because the work-up can be invasive and costly. ED is estimated to affect 20 % of men above 40 years of age, with the incidence increasing with increasing age. Erectile dysfunction has traditionally been seen as an age-dependent problem; however, approximately 2 % of men are affected at 40 years of age but this may be a gross underestimation secondary to reporting bias. Because ED is traditionally seen in the aging male population, studies regarding ED tend to be more frequently carried out among middle-aged and elderly men rather than in young men. These studies underline how comorbidities such as diabetes mellitus, cardiovascular or neurological pathologies, and medication use are strongly linked with ED. In addition, ED has been described to be associated with obesity or physical inactivity. This review article summarizes the important information that all sexual medicine providers should be familiar with when diagnosing, counseling, and treating young men with erectile dysfunction.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    N.C.C. Impotence. NIH consensus development panel on impotence. JAMA. 1993;270:83–90.

  2. 2.

    Laumann EO, West S, Glasser D, Carson C, Rosen R, Kang J-h. Prevalence and correlates of erectile dysfunction by race and ethnicity among men aged 40 or older in the United States: from the male attitudes regarding sexual health survey. J Sex Med. 2007;4:57–65.

  3. 3.

    Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381:153–65.

  4. 4.

    Zimmet PA, Albert KGMM, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782–7.

  5. 5.

    Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol. 1994;151:54–61.

  6. 6.

    Lue TF. Erectile dysfunction. N Engl J Med. 2000;342:1802–13.

  7. 7.

    Prieto D. Physiological regulation of penile arteries and veins. Int J Impot Res. 2007;20:17–29.

  8. 8.

    Williams SK, Melman A. Novel therapeutic targets for erectile dysfunction. Maturitas. 2012;71(1):20–7.

  9. 9.

    Rosen RC, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

  10. 10.

    Rosen RC et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

  11. 11.

    Rajkumar RP. The impact of disrupted childhood attachment on the presentation of psychogenic erectile dysfunction: an exploratory study. J Sex Med. 2015;12:798–803.

  12. 12.•

    Dicks B, Bastuba M, Goldstein I. Penile revascularization—contemporary update. Asian J Androl. 2013;15(1):5–9.

  13. 13.

    Sachs BD. The false organic-psychogenic distinction and related problems in the classification of erectile dysfunction. Int J Impot Res. 2003;15(1):72–8.

  14. 14.

    Davidson RJ, Pizzagalli D, Nitschke JB, Putnam K. Depression: perspectives from affective neuroscience. Annu Rev Psychol. 2002;53:545–74.

  15. 15.

    Ninan PT. The functional anatomy, neurochemistry, and pharmacology of anxiety. J Clin Psychiatry. 1999;60 Suppl 22:12–7.

  16. 16.

    Nutt DJ, Glue P, Lawson C. The neurochemistry of anxiety: an update. Prog Neuropsychopharmacol Biol Psychiatry. 1990;14:737–52.

  17. 17.

    Rosen R, Porst H, Montorsi F. The premature ejaculation prevalence and attitudes (PEPA) survey: a multi- national survey. 11th World Congress of the International Society of Sexual and Impotence Research, October 17–21.

  18. 18.

    Broderick GA, Arger P. Duplex Doppler ultrasonography: noninvasive assessment of penile anatomy and function. Semin Roentgenol. 1993;28:43–56.

  19. 19.••

    Yang Y, Hu JL, Ma Y, et al. Pharmaco-induced erections for penile color-duplex ultrasound: oral PDE5 inhibitors or intracavernosal injection? Int J Impot Res. 2012;24(5):191–5.

  20. 20.

    Lue TF, Hricak H, Marich KW, Tanagho EA. Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology. 1985;155:777–81.

  21. 21.

    Wasserman MD, Pollak CP, Spielman AJ, Weitzman ED. The differential diagnosis of impotence. The measurement of nocturnal penile tumescence. JAMA. 1980;243(20):2038–42.

  22. 22.

    Kessler WO. Nocturnal penile tumescence. Urol Clin N Am. 1988;15(1):81–6. Jun;12(3):373–80.

  23. 23.

    Karacan I, Scott FB, Salis PJ, Attia SL, Ware JC, Altinel A, et al. Nocturnal erections, differential diagnosis of impotence, and diabetes. Biol Psychiatry. 1977;12(3):373–80.

  24. 24.

    Licht MR, Lewis RW, Wollan PC, Harris CD. Comparison of RigiScan and sleep laboratory nocturnal penile tumescence in the diagnosis of organic impotence. J Urol. 1995;154:1740–3.

  25. 25.

    Levine AL, Lenting L. Use of nocturnal penile tumescence and rigidity in the evaluation of male erectile dysfunction. Urol Clin N Am. 1995;22:775–88.

  26. 26.

    Helgason AR, Arver S, Adolfson I, Dickman P, Granath F, Steineck G. ‘Potency’: the validation of information from a self-administered questionnaire using objective measurements of night-time erections and test-retest reliability. Br J Urol. 1998;81:135–41.

  27. 27.

    Karacan I, Williams RL, Thornby JI, Salis PJ. Sleep related penile tumescence as a function of age. Am J Psychiatry. 1975;132:932–7.

  28. 28.

    Cilurzo P, Canale D, Turchi P, Giorgi PM, Menchini Fabris GF. The RigiScan system in the diagnosis of male sexual impotence. Arch Ital Urol Androl. 1992;64 Suppl 2:81–5.

  29. 29.

    Puyau FA, Lewis RW. Corpus cavernosography. Pressure flow and radiography. Investig Radiol. 1983;18(6):517–22.

  30. 30.

    Rudnick J, Bödecker R, Weidner W. Significance of the intracavernosal pharmacological injection test, pharmacocavernosography, artificial erection and cavernosometry in the diagnosis of venous leakage. Urol Int. 1991;46(4):338–43.

  31. 31.

    Shabsigh R, Fishman IJ, Toombs BD, Skolkin M. Venous leaks: anatomical and physiological observations. J Urol. 1991;146(5):1260–5.

  32. 32.

    Motiwala HG, Patel DD, Joshi SP, Baxi HM, Desai KD, Shah KN. Experience with penile venous surgery. Urol Int. 1993;51(1):9–14.

  33. 33.

    Dorsey P, Keel C, Klavens M, Helstrom WJ. Phosphodiesterase type 5 (PDE5) inhibitors for the treatment of erectile dysfunction. Expert Opin Pharmacother. 2010;11:1109–22.

  34. 34.•

    Barnett ZL, Robleda-Gomez S, Pachana NA. Viagra: the little blue pill with big repercussions. Aging Ment Health. 2012;16(1):84–8.

  35. 35.••

    Goldstein I, McCullough AR, Jones LA, Hellstrom WJ, Bowden CH, Didonato K, et al. A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction. J Sex Med. 2012;9(4):1122–33.

  36. 36.

    Limin M, Johnsen N, Hellstrom WJ. Avanafil, a new rapid-onset phosphodiesterase 5 inhibitor for the treatment of erectile dysfunction. Expert Opin Investig Drugs. 2010;19(11):1427–37.

  37. 37.

    Burnett AL. Phosphodiesterase 5 mechanisms and therapeutic applications. Am J Cardiol. 2005;96(12B):29M–31M. Epub 2005 Jul 21. Review.

  38. 38.

    Cheitlin MD, Hutter Jr AM, Brindis RG, et al. ACC/AHA expert consensus document. Use of sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association. J Am Coll Cardiol. 1999;33:273–82.

  39. 39.

    Carson CC, Lue TF. Phosphodiesterase type 5 inhibitors for erectile dysfunction. BJU Int. 2005;96(3):257–80. Review.

  40. 40.

    Porst H, Giuliano F, Glina S, et al. Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5 mg and 10 mg in the treatment of erectile dysfunction: results of a multicenter, randomized, double-blind, placebo-controlled trial. Eur Urol. 2006;50:351–9.

  41. 41.

    Ströberg P, Hedelin H, Ljunggren C. Treatment of erectile dysfunction with PDE-5 inhibitors. Difficult for the physician to choose between the preparations—the patient should be given the opportunity to try out all three. Lakartidningen. 2006;103(14):1107–8. 1110–1.

  42. 42.

    Ljunggren C, Hedelin H, Salomonsson K, Ströberg P. Giving patients with erectile dysfunction the opportunity to try all three available phosphodiesterase type 5 inhibitors contributes to better long-term treatment compliance. J Sex Med. 2007;5(2):469–75.

  43. 43.•

    Carvalheira AA, Pereira NM, Maroco J, Forjaz V. Dropout in the treatment of erectile dysfunction with PDE5: a study on predictors and a qualitative analysis of reasons for discontinuation. J Sex Med. 2012;9:2361–9.

  44. 44.

    Palmer MJ, Bell AS, Fox DN, Brown DG. Design of second generation phosphodiesterase 5 inhibitors. Curr Top Med Chem. 2007;7(4):405–19. Review.

  45. 45.

    van Ahlen H, Peskar BA, Sticht G, Hertfelder HJ. Pharmacokinetics of vasoactive substances administered into the human corpus cavernosum. J Urol. 1994;151(5):1227–30.

  46. 46.

    Lue TF, Tanagho EA. Physiology of erection and pharmacological management of impotence. J Urol. 1987;137:829–36.

  47. 47.

    Zorgniotti AW, Lefleur RS. Auto-injection of the corpus cavernosum with a vasoactive drug combination for vasculogenic impotence. J Urol. 1985;133(1):39–41.

  48. 48.

    Bennett AH, Carpenter AJ, Barada JH. An improved vasoactive drug combination for a pharmacological erection program. J Urol. 1991;146(6):1564–5.

  49. 49.

    Floth A, Schramek P. Intracavernous injection of prostaglandin E1 in combination with papaverine: enhanced effectiveness in comparison with papaverine plus phentolamine and prostaglandin E1 alone. J Urol. 1991;145(1):56–9.

  50. 50.

    Linet OI, Neff LL. Intracavernous prostaglandin E1 in erectile dysfunction. Clin Investig. 1994;72(2):139–49.

  51. 51.

    Aboseif SR, Wetterauer U, Breza J, Benard F, Bosch R, Stief CG, et al. The effect of venous incompetence and arterial insufficiency on erectile function: an animal model. J Urol. 1990;144(3):790–3.

  52. 52.

    Fallon B. Intracavernous injection therapy for male erectile dysfunction. Urol Clin N Am. 1995;22(4):833–45.

  53. 53.

    Linet OI, Ogrinc FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group. N Engl J Med. 1996;334(14):873–7.

  54. 54.

    Michal V, Kramar R, Pospıchal J, Hejhal L. Direct arterial anastomosis on corpora cavernosa penis in the therapy of erective impotence. Rozhl Chir. 1973;52:587–90. Czech.

  55. 55.

    Michal V, Kramar R, Pospıchal J. Femoro-pudendal by-pass, internal iliac thromboendarterectomy and direct arterial anastomosis to the cavernous body in the treatment of erectile impotence. Bull Soc Int Chir. 1974;33:343–50.

  56. 56.

    Michal V. Arterial disease as a cause of impotence. Clin Endocrinol Metab. 1982;11:725–48.

  57. 57.

    Kayıgil O, Okulu E, Aldemir M, Onen E. Penile revascularization in vasculogenic erectile dysfunction (ED): long-term follow-up. BJU Int. 2011;109:109–15.

  58. 58.

    Sarramon JP, Malavaud B, Braud F, Bertrand N, Vaessen C, et al. Evaluation of male sexual function by the International Index of Erectile Function after deep dorsal vein arterialization of the penis. J Urol. 2001;166:576–80.

  59. 59.

    Munarriz R, Mulhall J, Goldstein I. Glenn’s Urologic Surgery. 6th ed, 2004, pgs. 573–581

  60. 60.

    Basar MM, Aydin G, Mert HC, Keles I, Caglayan O, Orkun S, et al. Relationship between serum sex steroids and Aging Male Symptoms score and International Index of Erectile Function. Urology. 2005;66(3):597–601.

  61. 61.

    Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804–14.

  62. 62.

    Buvat J, Maggi M, Guay A, Torres LO. Testosterone deficiency in men: systematic review and standard operating procedures for diagnosis and treatment. J Sex Med. 2013;10(1):245–84.

  63. 63.

    Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310(17):1829–36.

  64. 64.

    Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014;9(1):e85805.

  65. 65.

    Yoshimura N, Kato R, Chancellor MB, Nelson JB, Glorioso JC. Gene therapy as a future treatment for erectile dysfunction. Expert Opin Biol Ther. 2010;10:1305–14.

  66. 66.••

    Lin CS, Xin Z, Dai J, Huang Y-C, Lue TF. Stem-cell therapy for erectile dysfunction. Expert Opin Biol Ther. 2013;13:1585–97.

  67. 67.

    Morrison SJ, Shah NM, Anderson DJ. Regulatory mechanisms in stem cell biology. Cell. 1997;88:287–98.

  68. 68.

    Lin C-S, Xin Z-C, Deng C-H, Ning H, Lin G, Lue TF. Recent advances in andrology-related stem cell research. Asian J Androl. 2008;10:171–5.

  69. 69.

    Bochinski D, Lin GT, Nunes L, Carrion R, Rahman N, Lin CS, et al. The effect of neural embryonic stem cell therapy in a rat model of cavernosal nerve injury. BJU Int. 2004;94:904–9.

  70. 70.

    Bahk Y, Jung JH, Han H, Min SK, Lee YS. Treatment of diabetic impotence with umbilical cord blood stem cell intracavernosal transplant: preliminary report of 7 cases. Exp Clin Transplant. 2010;8:150–60.

  71. 71.

    Qiu X, Fandel TM, Ferretti L, Albersen M, Zhang H, Lin G, et al. Both immediate and delayed intracavernous injection of autologous adipose-derived stromal vascular fraction enhances recovery of erectile function in a rat model of cavernous nerve injury. Eur Urol. 2012;62:720–7.

  72. 72.

    Ponholzer A, Temml C, Mock K, et al. Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire. Eur Urol. 2005;47:80–6.

  73. 73.

    Laumann EO, Waite LJ. Sexual dysfunction among older adults: prevalence and risk factors from a nationally representative U.S. probability sample of men and women 57–85 years of age. J Sex Med. 2008;5:2300–11.

  74. 74.

    Bajos N, Wellings K, Laborde C, Moreau C. Sexuality and obesity, a gender perspective: results from French national random probability survey of sexual behaviours. BMJ. 2010;340:2573.

  75. 75.

    Janiszewski PM, Janssen I, Ross R. Abdominal obesity and physical inactivity are associated with erectile dysfunction independent of body mass index. J Sex Med. 2009;6:1990–8.

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  1. Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, New York, NY, 10016, USA
    • Seth D. Cohen
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Cohen, S.D. The Challenge of Erectile Dysfunction Management in the Young Man. Curr Urol Rep 16, 84 (2015). https://doi.org/10.1007/s11934-015-0553-3

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Keywords

  • Erectile dysfunction
  • Men’s health
  • Sexual medicine