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Introduction Worldwide, certain subsets of men bypass healthcare provider (HCP) interactions and obtain phosphodiesterase type 5 inhibitors (PDE5i) from uncontrolled sources. Aim To stratify men who are PDE5i users based on their obtaining patterns and investigate the characteristics that differentiate these groups. Methods A Web-based observational study conducted between March and June 2009 in Japan. Main Outcome Measures We stratified the reported obtaining patterns into three categories: men who had a prescription for PDE5is from HCP, those who obtained PDE5is from friends, and those who purchased PDE5is via the Internet. Logistic regressions were conducted to determine independent predictors for each obtaining patterns. Erection function was evaluated by erection hardness score (EHS). Results Of 7,710 total recruited subjects, 1,144 men (14.8%) reported PDE5i use within the past year. Among 1,144 men, 625 men (54.6%) were prescribed PDE5i from HCP, whereas 267 men (23.4%) obtained PDE5i from friends and 252 men (22.0%) purchased PDE5i via the Internet. In a multivariable regression analyses, men being prescribed PDE5i from HCP were more likely to live in a northern area of Japan (OR 0.98), have a lower rate of smoking (OR 0.77), and have an awareness of ED (OR 3.04). In contrast, men who obtained PDE5i from friends were more likely to live in a southern area (OR 1.02), to have higher rate of alcohol intake and smoking (OR 1.20, OR 1.45), and lower awareness of ED (OR 0.39). Men purchasing PDE5i via the Internet were more likely to consider themselves to be in worse health (OR 0.85) and to have lower awareness of ED (OR 0.62). Conclusions Our results could help to identify men who may bypass HCP interactions. These findings could aid in the targeting of public service announcements designed to encourage men to avoid obtaining uncontrolled PDE5i and consult with HCPs to protect their health.

Objective To compare the efficacy and safety of amoxapine and vitamin B12 for treating retrograde ejaculation (RE).Materials and Methods Between May 2009 and November 2012, this open-label, randomized, crossover study enrolled 26 men suffering with RE at Department of Reproductive Medicine, Omori Hospital. Patients were randomly allocated into two groups (n=13 each). The amoxapine-B12 group received amoxapine (50 mg daily for 4 weeks, orally) followed (after a 1-week washout period) by vitamin B12 (500 μg three-times daily for 4 weeks). The B12-amoxapine group received the opposite regimen. All patients masturbated to ejaculation at least twice during each treatment period. The primary outcome was antegrade ejaculation of semen, as reported by the patient, on more than one occasion during either treatment period (defined as treatment success). Any adverse events were noted. Success rates were compared between treatments using Fisher’s exact test.Results One patient (B12-amoxapine group) withdrew for personal reasons (breakdown of marital relations); all other patients completed the study. Overall success rate was 88% (22/25). Success rate was higher for amoxapine than for vitamin B12 (80%, 20/25 vs 16%, 4/25; P<0.0001). 18 patients were responsive to amoxapine but not to vitamin B12, 2 patients were responsive to vitamin B12 but not amoxapine, 2 patients were responsive to both drugs, and 3 patients had no response to either drug. One patient (4%) reported sleepiness and 2 (8%) reported constipation while receiving amoxapine. No adverse events were reported during vitamin B12 treatment.Conclusions Amoxapine may be an effective, safe and well-tolerated therapy for RE.

IntroductionErection hardness is an elemental component of men's sexual quality of life that can be easily measured by the Erection Hardness Score (EHS). However, there are few published data regarding EHS, and there is little understanding of its relationships to aging, men's sexual behavior, sexual confidence, and risk factors in Japan.AimTo assess EHS and how it correlates to aging, sexual behaviors, sexual self-confidence, and risk factors in a Japanese population database.MethodsA web-based cross-sectional nationwide survey conducted between March and May 2009 in Japan.Main Outcome MeasuresEHS, lifestyle factors, comorbidities, general health, sexual confidence, frequency of sexual behaviors, and attitudes toward treatment of erectile dysfunction (ED).ResultsA total of 7,710 men with a mean age of 39.3 ± 13.0 years participated in this survey. In 6,528 participants who were not using phosphodiesterase type 5 inhibitors, 3,540 (54.2%) had EHS ≤ 3 and 1,196 (18.3%) had EHS ≤ 2. We found a significant age-dependent decrease in EHS, sexual confidence, and frequency of sexual activities. Sexual confidence was strongly associated with higher EHS but was also associated with older age groups, presence of offspring, awareness of better general health, and greater frequency of sexual activity. In age-adjusted multivariate logistic regression, risk factors for a lower EHS (defined as EHS ≤ 2) were heavy smoking, which was defined as more than two packs per day (odds ratio [OR], 1.7) or a history of metabolic syndrome (OR, 1.4), hypertension (OR, 1.2), and diabetes mellitus (OR, 1.4).ConclusionsEHS correlates to various elements, such as aging, sexual behaviors, sexual confidence, and ED-related risk factors, and can be a valuable tool in clinical practice for monitoring and treating ED and thereby improving the quality of life for men and their sexual partners. Kimura M, Shimura S, Tai T, Kobayashi H, Baba S, Kano M, and Nagao K. A web-based survey of Erection Hardness Score and its relationship to aging, sexual behavior, confidence, and risk factors in Japan. Sex Med 2013;1:76–86.

Accumulating evidence indicates that varicocele repair improves sperm quality. However, longitudinal changes in sperm parameters and predictors of improved semen characteristics after surgery have not been fully investigated. We retrospectively reviewed data from 100 men who underwent microsurgical subinguinal varicocele repair at a single centre. Follow-up semen examinations were carried out at 3, 6 and 12 months post-operatively. Logistic regression was used to identify predictors of early (3 months) and late (≥6 months) improvement in semen parameters after varicocele repair. At 3 months post-operatively, 76.1% of the patients had improved total motile sperm counts, which continued to improve significantly up to 12 months post-operatively (p = .016). When comparing changes in semen parameters between younger (<37 years) and older (≥37 years) men, post-operative improvements in sperm concentration and motility were greater among younger men. Multivariate analysis showed that younger age was associated with early (p = .043) and late (p = .010) post-operative improvement in total motile sperm count. Our findings indicate that early varicocele repair improved semen parameters after surgery.