Introduction Improvement in glycemic control is likely to reduce the risk of diabetic complication, while its effect on erectile dysfunction (ED) remains unclear. Aim The aim of this study was to evaluate the association of glycemic control with risk of ED in type 2 diabetics. Methods A self-administered questionnaire containing Sexual Health Inventory for Men was obtained from 792 subjects with type 2 diabetes at our institution. Clinical data were obtained through chart review. Main Outcome Measures The contribution of glycemic control assessed by glycated hemoglobin (HbA1c) level as well as age, duration of diabetes, hypertension (HT), dyslipidemia, and cigarette smoking to risk of ED was evaluated. Results Of 792 subjects, 83.6% reported having ED and 43.2% had severe ED. HbA1c level (%) adjusted for age and duration of diabetes was significantly associated with ED (OR 1.12, 95% CI: 1.01–1.25). None of HT, dyslipidemia, and cigarette smoking was a significant risk factor for ED after adjusted for age and duration of diabetes. HbA1c level, age, and duration of diabetes were significant independent risk factors for ED among the younger group (age ≤ 60 years), and only age and duration of diabetes were independent risk factors among the older group (age > 60 years). For the risk of severe ED, compared with no and mild to moderate ED, HbA1c level, duration of diabetes, and HT were independent risk factors among the younger group, and only age was an independent factor among the older group. Conclusions Better glycemic control probably would reduce the prevalence of ED and its severity among the younger men with type 2 diabetes. For the older group, aging was the major determinant for ED risk among this population with type 2 diabetes.

To assess the compliance of treatment, its affecting factors, and reasons for dropout, a questionnaire was mailed to a cohort of 2139 subjects who received sildenafil prescriptions for erectile dysfunction (ED) at our institution from 1999 to 2002. A total of 726 subjects (34%) with a mean age of 67 years answered the questionnaires. The response rate for sildenafil treatment was 67%. Of these sildenafil responders, 43% reported that they continued using sildenafil while 57% did not, in a mean follow-up of 3 years. Common reasons for discontinuation were effect below expectations, high cost, loss of interest in sex, and inconvenience in obtaining sildenafil. The continuers showed a higher rate than the discontinuers (P < 0.05) of having tried other treatments, dose titration, and a dose higher than 50 mg. The discontinuers reported having a lower mean responding dose and improvement score post sildenafil treatment than the continuers. In conclusion, effect below expectations was the leading reason for discontinuation of sildenafil treatment. How ED subjects tried the medication and the adequacy of education in the initial treatment period may impact the compliance of sildenafil treatment.

Introduction Female sexual function contains four major subtypes of desire, arousal, orgasm, and pain. Few studies used validated instruments to determine the dysfunction in these areas and assess their risk factors. Aim To assess the prevalence of and risk factors for individual components of sexual difficulty in women. Methods A self-administered questionnaire containing the Female Sexual Function Index (FSFI) was given to 2,159 woman employees of two hospitals to assess their sexual function and its correlates. Main Outcome Measures The associations between female sexual difficulty in individual domains defined by the FSFI domain scores and potential risk factors assessed by simple questions. Results Among the 1,580 respondents, 930 women’s data were eligible for analysis with a mean age of 36.1 years (range 20–67). Of them, 43.8% had sexual difficulty in one or more domains, including low desire in 31.3%; low arousal, 18.2%; low lubrication, 4.8%; low orgasmic function, 10.4%; low satisfaction, 7.3%; and sexual pain, 10.5%. Compared with the younger women (20–49 years), the oldest age group (50–67 years) had a significantly higher prevalence in low desire, low arousal, and low lubrication, but not in the other domains. Based on multivariate logistic regression analyses, poor relationship with the partner and perception of partner’s sexual dysfunction were major risk factors for low desire, low arousal, low orgasmic function, and low satisfaction. Age and urge urinary incontinence were associated with low lubrication and sexual pain. Most comorbidities were not related to these difficulties, except diabetes being related to low desire. Conclusions Relationship factors had substantial impact on female sexual function in desire, arousal, orgasm, and satisfaction. On the other hand, women’s lubrication problem and sexual pain were related predominantly with biological factors. These are initial results and future research is needed to confirm them.

Introduction Despite being seen as aphrodisiacs, illicit drugs are reported to have detrimental effects on male sexual function but most studies have been based on small case numbers with ambiguous results. Aims To assess the impact of illicit drugs abuse on male sexual function. Main Outcome Measures International Index of Erectile Function (IIEF) and global assessment questions. Methods Illicit drug abusers in a Drug Abstention and Treatment Center were recruited to complete the questionnaires and their data were compared with an age-matched control. Results The abusers (N = 701, mean age 33.8 years) had a lower mean IIEF score in each domain than that of the controls (N = 196, mean age 35.4 years). Heroin, amphetamine, and MDMA (“Ecstasy”) were the leading drugs used. Erectile dysfunction (ED) was reported in 36.4% of the abusers and the odds ratio of having ED (compared with the controls) in mono-users of heroin, amphetamine, and MDMA was 4.8 (P &lt; 0.05), 3.2 (P &lt; 0.05), and 1.4 (P &gt; 0.05), respectively. Of the abusers, 38.6% reported to have decreased sexual desire with illicit drug use, more often seen in the heroin mono-users (46.7%), and 18.4% reported to have enhanced sexual desire, more often seen in the amphetamine mono-users (22.6%). Mean IIEF sexual desire domain score of the abusers was lower than that of the control, even for those who reported to have enhanced sexual desire. Increased and decreased ejaculation latency affected by illicit drugs was reported in 49.9 and 14.3%, respectively, of the abusers, showing no significant difference among the mono-users of three different drugs. Conclusions Illicit drug male abusers were prone to have ED, decreased sexual desire, and increased ejaculation latency. ED and decreased sexual desire were most commonly seen in heroin, followed by amphetamine and MDMA mono-users, while increased ejaculation latency occurred commonly in all of the abusers.

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In order to assess the prevalence of erectile dysfunction (ED), and its association with chronic diseases and impact upon sexual activity and satisfaction during sexual intercourse, a reproductive survey was conducted among 1002 Taiwanese men aged over 40 y. The information collected comprised age, gender, level of education, history of chronic diseases, and self-reported data pertaining to erectile function, sexual activity, and sexual satisfaction during sexual intercourse. The prevalence of ED amongst study subjects was 17.7%, and the frequency increased with age. A history of chronic diseases were significantly associated with ED (Po0.05). A reduced incidence of sexual activity and a decreased level of satisfaction during sexual intercourse were observed among subjects suffering from ED as compared to those not suffering such a condition. In conclusion, based upon the results of a community-based survey the prevalence of ED among Taiwanese men aged 40 y or more was 17.7% and it increased with age. It was also found that ED was associated with various chronic diseases and that it exerted a negative impact upon sexual activity and the level of satisfaction associated with its conduct.

Introduction The effect of systemic lupus erythematosus (SLE) on women’s sexual functioning has been rarely assessed. Aim The aim of this study is to evaluate the impact of SLE on women’s sexual functioning. Methods A total of 302 consecutive female outpatients with SLE were provided with a questionnaire composed of the Female Sexual Function Index (FSFI), questions for sociodemographic characteristics and comorbidities. Similarly, 2,159 hospital female employees were assessed as the control group. In patients, data of SLE duration and Sjögren’s syndrome were derived from the chart records and the disease activity was assessed using the SLE Disease Activity Index 2000. Main Outcome Measures The FSFI scores were compared between the patients and the controls. Correlates of the FSFI scores were determined in the patients. Results Of 302 eligible patients, 92.4% (279/302) responded, in addition to 73.2% (1,580/2,159) of controls. Ninety-five percent (255/268) of the respondent patients were in no-to-mild SLE disease activity. Among the respondents, 171 (61.3%) patients and 930 (58.9%) controls were sexually active in the previous month, P = 0.446. Of the sexually active patients, 52.5% (85/162) had impaired sexual function (the FSFI total score &lt; 26.55) and so did 47.1% (408/867) of the sexually active controls, P = 0.206. With adjustment of age group, marital status and education level, patients had lower FSFI scores than controls only in the domains of lubrication and pain. Significant risk factors for lower FSFI scores in the patients included persistent activity or flare of SLE, menstrual cycle disturbances, and vascular disease. With further adjustment of other risk factors, only vascular disease remained significant as a risk factor for impaired sexual function (odds ratio = 5.7; 95% confidence interval 1.6–20.1). Conclusion When not in an exacerbation period, the impact of SLE on women’s sexual functioning is not great and is related to vascular factors.

Introduction Tadalafil is a phosphodiesterase type 5 inhibitor for the treatment of erectile dysfunction (ED). Past clinical trials have assessed its efficacy and safety in western populations. Tadalafil has not been investigated in a large clinical trial with a South-east Asian population. Aim To assess the efficacy and safety of on-demand tadalafil for the treatment of ED in a 12-week, double-blind, placebo-controlled study in Taiwan. Methods Men with mild to severe ED of various etiologies were randomized to receive placebo, tadalafil 10 mg, or tadalafil 20 mg, taken as needed (maximum once daily). Efficacy assessments included the International Index of Erectile Function, the Sexual Encounter Profile (SEP) diary, and a Global Assessment Question (GAQ). Results Tadalafil significantly improved erectile function compared with placebo (P &lt; 0.005, all measures). At endpoint, the patients receiving tadalafil reported a greater mean per-patient percentage of successful intercourse attempts (SEP question 3: 70.0%, 10 mg; 78.0%, 20 mg) than placebo-treated patients (42.8%) and a greater proportion of improved erections (GAQ: 92.3% and 84.6% vs. 54.5%). Most treatment-emergent adverse events were mild or moderate. The most common adverse events were back pain, dyspepsia, and myalgia. Conclusions Tadalafil was an effective, well-tolerated therapy for men in Taiwan with ED of broad-spectrum severity and etiology.