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Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment
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Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Reproductive Medicine & Andrology".

Deadline for manuscript submissions: closed (15 November 2022) | Viewed by 18117

Special Issue Editor

Dr. Fernando Mazzilli

E-Mail Website
Guest Editor
1. Andrology Unit, Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Sant'Andrea Hospital, via di Grottarossa 1038, Rome, Italy
2. AIED Center for Reproductive Medicine, Via Toscana 30, Rome, Italy
Interests: erectile dysfunction; sexual function; hypogonadism; infertility; semen analysis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Erectile dysfunction (ED) is the inability to achieve and keep an erection firm enough for sexual intercourse. ED is an induced combination of vasculogenic, neurogenic, endocrinological/metabolic (hypogonadism, hyperprolactinemia, diabetes, osteoporosis), drug-induced (psychotropics, anti-hypertensive) and psychological causes, including sexual dysfunctions due to infertility conditions. It can be classified as psychogenic, organic or mixed psychogenic and organic. Approximately 20%–30% of adult men have at least one sexual dysfunction.

The role of age is an important risk factor, as ED increases with increasing age, in association with other comorbidities. Furthermore, ED could be considered a risk factor for heart disease, similarly to a history of smoking or a family history of coronary artery disease, or diabetes and other systemic diseases. Finally, due to all of these reasons, investigating ED could be useful to ameliorate the prevention or the treatment of some of the most widespread acute and chronic diseases.

This Special Issue will explore ED aetiology, comorbidity and management based on a combination of original research and review papers.

Topics will include:
the epidemiology of ED; causes of ED; the relationship between infertility and ED; diagnostic approaches of ED; comorbidity of ED: diagnosis and management; interventions for ED.

Dr. Fernando Mazzilli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • erectile dysfunction
  • hypogonadism
  • diabetes
  • gonadal function
  • sexual function
  • male infertility

Related Special Issue

Published Papers (7 papers)

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Editorial

Jump to: Research, Review

6 pages, 186 KiB  
Editorial
Erectile Dysfunction: Causes, Diagnosis and Treatment: An Update
by Fernando Mazzilli
J. Clin. Med. 2022, 11(21), 6429; https://doi.org/10.3390/jcm11216429 - 30 Oct 2022
Cited by 7 | Viewed by 6318
Abstract
Erectile Dysfunction (ED) is defined as “recurrent and persistent inability, partial or complete, to achieve or maintain an erection firm enough for satisfactory sexual intercourse in the presence of proper erotic stimuli”; the concept of ED replaced the previous definition of “impotence” [...] [...] Read more.
Erectile Dysfunction (ED) is defined as “recurrent and persistent inability, partial or complete, to achieve or maintain an erection firm enough for satisfactory sexual intercourse in the presence of proper erotic stimuli”; the concept of ED replaced the previous definition of “impotence” [...] Full article
(This article belongs to the Special Issue Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment)

Research

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9 pages, 241 KiB  
Article
Erectile Dysfunction Severity: The Role of Glycometabolic Compensation and Antihyperglycemic Drugs
by Virginia Zamponi, Giuseppe Defeudis, Francesca Federico, Antongiulio Faggiano and Rossella Mazzilli
J. Clin. Med. 2022, 11(23), 7214; https://doi.org/10.3390/jcm11237214 - 05 Dec 2022
Cited by 1 | Viewed by 1093
Abstract
Background: The aim of this study was to evaluate the prevalence of DM among patients with ED and the impact of glycometabolic compensation and antihyperglycemic treatment on ED severity. Methods: In total, 1332 patients with ED were enrolled. The diagnosis was performed through [...] Read more.
Background: The aim of this study was to evaluate the prevalence of DM among patients with ED and the impact of glycometabolic compensation and antihyperglycemic treatment on ED severity. Methods: In total, 1332 patients with ED were enrolled. The diagnosis was performed through the International-Index-of-Erectile-Function questionnaire. ED severity was considered according to presence/absence of spontaneous erections, maintenance/achievement deficiency and response to PDE5-i. DM patients were clustered according to antihyperglycemic treatment: “metformin”/“insulin”/“old antihyperglycemic drugs”/“new antihyperglycemic drugs”. Results: The prevalence of DM patients was 15.8% (Group A, patients with ED and DM). Among these, the prevalence of spontaneous erections (21.0%) was lower than in the remaining patients (Group B, patients with ED without DM) (32.0%, p < 0.001). The prevalence of poor response to PDE5-i was lower in Group B (10.0%) than in Group A (35.0%, p < 0.001). Patients with good response to PDE5-i therapy showed lower HbA1c values than patients with poor/no response (6.6 ± 1.1% vs. 7.7 ± 1.9%, p = 0.02). The prevalence of absent response to PDE5-i was higher in patients treated with old antidiabetic drugs than in the population treated with new drugs (p = 0.03). Conclusion: The severity of ED and lower response to PDE5-i were higher in DM patients. A better glycometabolic profile, as well as new antihyperglycemic drugs, seem to have a positive effect on ED. Full article
(This article belongs to the Special Issue Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment)
8 pages, 624 KiB  
Article
Glycemic Variability in Subjects with Diabetes and Hypogonadism during Testosterone Replacement Treatment: A Pilot Study
by Giuseppe Defeudis, Ernesto Maddaloni, Giovanni Rossini, Alfonso Maria Di Tommaso, Rossella Mazzilli, Paolo Di Palma, Paolo Pozzilli and Nicola Napoli
J. Clin. Med. 2022, 11(18), 5333; https://doi.org/10.3390/jcm11185333 - 11 Sep 2022
Cited by 2 | Viewed by 1232
Abstract
Background: This is a proof of concept, as a pilot study, with the aim to evaluate continuous glucose monitoring metrics (CGM) in subjects with type 2 diabetes (T2DM), treated with nutritional therapy and metformin, before and after testosterone replacement therapy (TRT). Methods: In [...] Read more.
Background: This is a proof of concept, as a pilot study, with the aim to evaluate continuous glucose monitoring metrics (CGM) in subjects with type 2 diabetes (T2DM), treated with nutritional therapy and metformin, before and after testosterone replacement therapy (TRT). Methods: In this longitudinal observational study, subjects affected by T2DM and starting TRT for documented ED and hypogonadism were enrolled. All subjects mounted a CGM system during the v0 visit, one week before the beginning of the TRT (week−1), during v2, four weeks after the start of TRT (week 4), and v4 (week 12). CGM was worn for about 144 h after each visit. Results: A total of seven patients, referring to our clinic for erectile dysfunction (ED), were studied (aged 63.3 ± 2.3 years). Mean (± standard deviation) total testosterone level was 2.3 ± 0.6 ng/mL at baseline. After TRT, total testosterone level was 4.6 ± 3.04 ng/mL at week 4 and 3.93 ± 4.67 ng/mL at week 12. No significant differences were observed in TIR, TAR, TBR, estimated HbA1c, AUC below, and AUC above limit during the intervention period. Conclusions: This is the first study evaluating the effects of TRT on daily glucose excursions in subjects with T2DM and hypogonadism. Though we did not find any significant difference in key CGM metrics during the 12 weeks of TRT, this study confirms the glycometabolic safety of the TRT even on the most novel standardized glycemic targets. Full article
(This article belongs to the Special Issue Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment)
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10 pages, 1101 KiB  
Article
The Role of Antihyperglycemic Drugs and Diet on Erectile Function: Results from a Perspective Study on a Population with Prediabetes and Diabetes
by Giuseppe Defeudis, Alfonso Maria Di Tommaso, Claudia Di Rosa, Danilo Cimadomo, Yeganeh Manon Khazrai, Antongiulio Faggiano, Raffaele Ivan Cincione, Nicola Napoli and Rossella Mazzilli
J. Clin. Med. 2022, 11(12), 3382; https://doi.org/10.3390/jcm11123382 - 13 Jun 2022
Cited by 6 | Viewed by 1567
Abstract
Background. The purpose of this study was to evaluate the effect of diet and antihyperglycemic drugs on erectile dysfunction (ED) in a setting of subjects affected by diabetes mellitus (DM) or preDM. Methods. This is a prospective observational study on 163 consecutive subjects [...] Read more.
Background. The purpose of this study was to evaluate the effect of diet and antihyperglycemic drugs on erectile dysfunction (ED) in a setting of subjects affected by diabetes mellitus (DM) or preDM. Methods. This is a prospective observational study on 163 consecutive subjects with preDM or DM. All patients have undergone a medical evaluation (age, Body Mass Index (BMI), family history of DM, duration of DM, smoking, physical activity, dyslipidemia, cardiovascular comorbidities, and testosterone and HbA1c levels) and the International Index of Erectile Function (IIEF)-5 questionnaire. Results. Overall, the mean age was 62.8 ± 9.3 years, and the mean BMI was 28.4 ± 4.6 kg/m2. The IIEF-5 score mean value was 14.4 ± 6.2 (range 4–25). Among all confounders investigated for their association with the IIEF-5 score, only age and the duration of DM among diabetic patients showed a significant trend. The IIEF-5 score was higher in patients using GLP-1a compared to insulin (16.7 ± 4.7 vs. 12.9 ± 6.2; p = 0.02). This association was confirmed after adjustment for age and duration of DM (p = 0.01). All other treatments were similar (14.9 ± 6.2, 14.8 ± 9.2, 15.3 ± 5.4, and 13.6 ± 6.8 for metformin, sulfonylureas (SU), dipeptidyl-peptidase-4 inhibitors (DPP-4i), and sodium-glucose cotransporter-2 inhibitors (SGLT2i) treatment, respectively). Conclusions. This prospective observational study increases attention and focus on the effect of antihyperglycemic drugs and diet on ED, above all about the role of new classes, showing a significant higher IIEF-5 mean value in patients using GLP-1a compared to patients on insulin treatment. Full article
(This article belongs to the Special Issue Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment)
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13 pages, 2817 KiB  
Article
Rubus occidentalis and Ellagic Acid Affect the Contractility of Penile Corpus Cavernosum Smooth Muscle through the Nitric Oxide-Cyclic Guanosine Monophosphate and Cyclic Adenosine 3′,5′-Monophosphate Signaling Pathway
by Keshab Kumar Karna, Bo-Ram Choi, Chul-Young Kim, Hye-Kyung Kim and Jong-Kwan Park
J. Clin. Med. 2022, 11(10), 2947; https://doi.org/10.3390/jcm11102947 - 23 May 2022
Cited by 3 | Viewed by 1938
Abstract
The present study was designed to evaluate the relaxation effect of Rubus occidentalis (RO) and ellagic acid (EA) on rabbit penile corpus cavernosum smooth muscle (PCCSM). Rabbit PCCSM was treated with ROE or EA after preincubation with nitric oxide synthase (NOS), guanylate cyclase [...] Read more.
The present study was designed to evaluate the relaxation effect of Rubus occidentalis (RO) and ellagic acid (EA) on rabbit penile corpus cavernosum smooth muscle (PCCSM). Rabbit PCCSM was treated with ROE or EA after preincubation with nitric oxide synthase (NOS), guanylate cyclase (GC), adenylyl cyclase (AC) or protein kinase A (PKA) blocker. Cyclic nucleotides in the perfusate were analyzed using radioimmunoassay (RIA). Subsequently, perfused PCCSMs were subjected to analysis to evaluate the expression level of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS). The interaction of ROE or EA with phosphodiesterase (PDE) 5 and PDE4 inhibitors, such as udenafil (UDE) and rolipram (ROL), were also evaluated. Both ROE and EA relaxed the PCCSM in a concentration-dependent manner. Coincubation of ROE or EA with NOS, GC, AC, or PKA blocker significantly decreased the ROE- and EA-induced relaxation. Pretreatment of ROE and EA significantly upregulated the cyclic guanosine monophosphate (cGMP), cyclic adenosine 3′,5′-monophosphate (cAMP), and eNOS levels in the perfused PCCSM. Furthermore, the treatment of ROE and EA markedly increased the UDE- and ROL-induced relaxation of the PCCSM. In conclusion, ROE and EA induced PCCSM relaxation by activating the nitric oxide (NO)-cGMp and cAMp signaling pathways and may have a synergistic action to improve erectile function. Full article
(This article belongs to the Special Issue Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment)
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11 pages, 1232 KiB  
Article
A Natural History of Erectile Dysfunction in Elderly Men: A Population-Based, Twelve-Year Prospective Study
by Jouko Saramies, Markku Koiranen, Juha Auvinen, Hannu Uusitalo, Esko Hussi, Sebastian Becker, Sirkka Keinänen-Kiukaanniemi, Jaakko Tuomilehto and Kadri Suija
J. Clin. Med. 2022, 11(8), 2146; https://doi.org/10.3390/jcm11082146 - 12 Apr 2022
Cited by 3 | Viewed by 2612
Abstract
There is a wide variation in the development and course of erectile dysfunction (ED) in men, which confirms the need for prospective studies. We conducted a cross-sectional analysis among the general male population at the baseline (n = 359) and in a [...] Read more.
There is a wide variation in the development and course of erectile dysfunction (ED) in men, which confirms the need for prospective studies. We conducted a cross-sectional analysis among the general male population at the baseline (n = 359) and in a follow-up survey (n = 218) 12 years later. The prospective 12-year study included 189 men. ED was assessed using the International Index of Erectile Function questionnaire. The mean age of the participants was 62.0 years at the baseline, while at the 12-year follow-up it was 71.6 years. The crude prevalence of ED was 61.6% at the baseline and 78.9% at the follow-up, and the prevalence tended to increase with age. All of the men aged 75 years or more had at least mild ED. The incidence of ED in every thousand person years was 53.5. A total of 54.5% of the men experienced ED progression, while 39.2% reported no changes in erectile function, and 6.3% experienced ED regression during the 12-year study. The likelihood of ED progression was higher in the older compared with younger age group (odds ratio, OR 5.2 (95% CI: 1.1–26.2)), and the likelihood of ED regression was lower among men with increased depression symptoms (OR 0.3 (95% CI: 0.1–0.6)) and among men with a decreased interest in their sexual life (OR 0.1 (95% CI: 0.0–0.6)). Lifestyle factors such as the consumption of alcohol and smoking were not significantly associated with ED. Full article
(This article belongs to the Special Issue Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment)
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Review

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22 pages, 2156 KiB  
Review
The Race to Replace PDE5i: Recent Advances and Interventions to Treat or Manage Erectile Dysfunction: Evidence from Patent Landscape (2016–2021)
by Mohammed Monirul Islam, Nimbagal Raghavendra Naveen, Posina Anitha, Prakash S. Goudanavar, G. S. N. Koteswara Rao, Santosh Fattepur, Muhammad Muhitur Rahman, Predeepkumar Narayanappa Shiroorkar, Mohammed Habeebuddin, Girish Meravanige, Mallikarjun Telsang, Sreeharsha Nagaraja, Syed Mohammed Basheeruddin Asdaq and MD. Khalid Anwer
J. Clin. Med. 2022, 11(11), 3140; https://doi.org/10.3390/jcm11113140 - 31 May 2022
Cited by 3 | Viewed by 2579
Abstract
For a few decades, globally, erectile dysfunction (ED) has become more prominent even in young adults and represents a mounting health concern causing a significant effect on men’s quality of life. There is an expectation that by the end of 2025, the number [...] Read more.
For a few decades, globally, erectile dysfunction (ED) has become more prominent even in young adults and represents a mounting health concern causing a significant effect on men’s quality of life. There is an expectation that by the end of 2025, the number of ED cases can rise to 322 million. We aimed to comprehensively analyze the scientific output of scholarly articles and studies in the field of ED (2016–2021). Data from scholarly articles were collected using Pubmed, and clinical trials-related information was accessed from the clinical trials website. An extensive patent search was conducted using databases such as USPTO (United States patent and trademark office) and EPO (European patent office), WIPO (World Intellectual Property Organization), etc. Owing to the high market value of ED drugs, considerable interest was attained to grab the opportunities. The race to replace the phosphodiesterase type 5 inhibitor (PDE5 inhibitor-PDE5i) can be identified as evident from the significant number of patents filed and the inventions cleared with clinical trials. Some other intriguing interventions are identified for ED treatment but have yet to gain public acceptance. The current analysis confirms the overall evolution and unexplored corners of research on ED treatment strategies with a current global projection. Full article
(This article belongs to the Special Issue Erectile Dysfunction (ED): Symptoms, Diagnosis and Treatment)
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