Introduction There have been limited multiregional studies in Asia examining the parameters of men's general and sexual health and quality of life in the general population vs. those in clinical cohorts of patients with erectile dysfunction (ED). Aims The aims of the Asian Men's Attitudes to Life Events and Sexuality (Asian MALES) study were to investigate the prevalence of ED, associated health conditions, and ED treatment-seeking patterns in the general male population in five regions of Asia (China, Japan, Korea, Malaysia, and Taiwan). Main Outcome Measure Standardized questionnaire previously used in a similar multiregional study and modified to ensure culturally appropriate content for Asia. Methods Phase I of the study involved 10,934 adult men, aged 20–75 years, who were interviewed using the standardized questionnaire. Phase II of the study involved men with self-reported ED recruited from Phase I and via physician referral, invitations in general practitioner offices, and street interception (total Phase II sample, N=1,209). Results The overall prevalence of self-reported ED in the Phase I study population was 6.4%. ED prevalence varied by region and significantly increased with age (P <0.01). Men with ED reported significantly greater rates of comorbid illness (P <0.0001) and a reduced quality of life (P =0.0001), compared with men without ED. Phase II of the study revealed that fewer than half of men with self-reported ED had sought treatment for their problem. Men were more likely to seek help for erection difficulties from Western doctors than from traditional medicine practitioners (P =0.0001). A man's partner/spouse was the most common influencer of treatment seeking in all regions except Malaysia. Conclusion The findings confirm those of existing research on ED in both Asian and non-Asian males: ED is a prevalent condition; the prevalence of ED increases with age and is strongly associated with comorbid conditions; and the majority of men have never sought treatment for their condition. This study highlights a substantial need for the evaluation and treatment of ED in Asian men.

Identifying men's perceptions of ED and its treatment would help doctors in their consultation, and inform health policy makers in planning appropriate public education and services.

Asian cultures have different belief systems and health seeking behaviors and they believe strongly in the holistic approach to medicine and health. Asian traditional medicine emphasizes the importance of prevention of illnesses and development of natural resistance to disease, and thus believes in the promotion of general well-being. Asian traditional medicine predominates in the Asian countries, and it is used for the treatment of various physical and mental illnesses. It has also been used for the treatment of sexual dysfunction, namely erectile dysfunction (ED) in men. However, the majority of research into the safety and efficacy of medicinal plants or herbs are mainly based on animal models and very limited studies on humans, probably due to negative clinical trial results, drug interactions or toxic reactions. It is generally very difficult to identify the actual ingredient of a herbal medication that is effective for the treatment of ED. Various traditional medicines, such as herbal medicine or animal products, which are used for the treatment of ED are discussed in this paper. It is important for physicians treating ED to know about the various traditional medicines and the perception and beliefs of ED sufferers regarding traditional therapies. Physicians should understand the potential associated health risks of various traditional medicines because of possible adverse events, drug interactions, contamination or adulteration of the medicine. Finally, practitioners treating ED should recognize and emulate the emphatic and approachable qualities of traditional therapists.

Gynura bicolor (Compositae) is a popular vegetable in Asia and believed to confer a wide range of benefits including anti-cancer. Our previous findings showed that the ethyl acetate extract of G. bicolor possessed cytotoxicity and induced apoptotic and necrotic cell death in human colon carcinoma cells (HCT 116). A combination of column chromatography had been used to purify chemical constituents from the ethyl acetate and water extract of G. bicolor leaves. Eight chemical constituents 5-p-trans-coumaroylquinic acid (I), 4-hydroxybenzoic acid (II), rutin (III), kampferol-3-O-rutinoside (IV), 3,5-dicaffeoylquinic acid (V), kampferol-3-O-glucoside (VI), guanosine (VII) and chlorogenic acid (VIII) were isolated from G. bicolor grown in Malaysia. To our best knowledge, all chemical constituents were isolated for the first time from G. bicolor leaves except rutin (III). 3,5-dicaffeoylquinic acid (V), guanosine (VII) and chlorogenic acid (VIII) demonstrated selective cytotoxicity (selective index>3) against HCT 116 cancer cells compared to CCD-18Co human normal colon cells.

Tadalafil was an effective and well-tolerated treatment for ED in East and Southeast Asian men.

This qualitative study aimed to examine cultural differences in knowledge, attitudes and practices related to erectile dysfunction (ED) utilizing focus group discussion. Six focus groups consisting of 66 men, 45 -70-y-old were conducted -two Malay groups (n ¼ 18), two Chinese groups (n ¼ 25) and two Indian groups (n ¼ 23). Participants were purposively recruited from the general public on a voluntary basis with informed consent. Transcripts were analyzed using qualitative data analysis software ATLASti. The Malay and Chinese traditional remedies for preventing or treating ED are commonly recognized among all races. Many have a negative perception of someone with ED. Malay and Chinese men tended to blame their wife for their problem and thought that the problem might lead to extra-marital affairs, unlike the Indian men who attributed their condition to fate. Malays would prefer traditional medicine for the problem. The Chinese felt they would be more comfortable with a male doctor whilst this is not so with the Malays or Indians. Almost all prefer the doctor to initiate discussion on sexual issues related to their medical condition. There is a need for doctors to consider cultural perspectives in a multicultural society as a lack of understanding of this often contributes to an inadequate consultation. Keywords: qualitative research; focus group discussion; culture; erectile dysfunction IntroductionErectile dysfunction (ED) is defined as the persistant inability of the male to attain and maintain a penile erection sufficient to permit satisfactory sexual intercourse. 1 -3 It is one of the most common chronic medical disorders in men over the age of 40 y. 4 It has been reported that ED is present in approximately half of all men between the ages of 40 and 70. 5 It has been noted that the prevalence rate is associated with age. Baseline data from the Massachusetts Male Aging Study suggested that the continued prevalence of minimal, moderate, and complete ED was as high as 52%. The prevalence of minimal ED was 25%, and 10%, respectively. 6 In Malaysia, results from a cross-national study on the prevalence and correlates of ED conducted by the National Population and Family Development Board and the New England Research Institutes, USA showed that more than 40% of men between 40 and 45 y of age are affected by ED. 7 ED is a commonly reported condition among Malaysian men with more than 70% of the sample saying that they would seek medical consultation on ED. It is estimated to affect approximately one million men in Malaysia. This is an estimated figure (of 1%) from the worldwide estimate of more than 100 million men. 7 Variations in the perceptions and attitudes towards ED are linked to cultural, ethnicity and other social factors. Locally, there has been a scarcity of data pertaining to cultural, ethnicity and sociodemographic variables with relation to ED. This study was carried out to examine the cultural differences between the Malays, Chinese and Indian's knowledge of, attitudes towards, and practices related ...

This study aimed to investigate the effect of intramuscular injection of testosterone undecanoate on overall quality of life (QoL) in men with testosterone deficiency syndrome (TDS). A randomized controlled trial over a 12-month period was carried out in 2009. One hundred and twenty men aged 40 years and above with a diagnosis of TDS (serum total testosterone ,12 nmol l 21 and total Aging Male Symptom (AMS) scores o27) were invited to participate. Interventions comprised intramuscular injection of either placebo or 1000 mg testosterone undecanoate, given at weeks 0, 6, 18, 30 and 42. This paper presents the secondary analysis of QoL changes measured in the scores of Short-Form-12 (SF-12) scale at baseline, weeks 30 and 48 after the first injection. A total of 56/60 and 58/60 men from the active treatment and placebo group, respectively, completed the study. At week 48, before adjusting for baseline differences, the QoL of men in the treatment group improved significantly in five out of the eight domains on SF-12. The physical health composite scores improved 4.0 points from a baseline of 41.967.0 in the treatment group compared to 0.8 point from a baseline of 43.767.1 in the placebo group (F53.652, P50.027). The mental health composite scores improved 4.4 points from a baseline of 37.169.0 in the treatment group compared to 1.0 points from a baseline of 37.667.9 in the placebo group (F54.514, P50.018). After adjusting for baseline differences, significant improvement was observed in mental health composite scores, but not in physical health composite scores. Long-acting testosterone undecanoate significantly improved the mental health component of QoL in men with TDS.

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