Erectile Dysfunction Gives Early Warning Of A Heart Attack, Warns Expert

Erectile dysfunction gives a two to three year early warning of a heart attack, warns an expert on the British Medical Journal website.

But the link between erectile dysfunction and the risk of heart disease is being ignored by doctors, writes Dr Geoffrey Hackett from the Good Hope Hospital in Birmingham.

Over many years Hackett reports regularly seeing patients referred with erectile dysfunction after a heart attack, only to hear that they had developed erectile dysfunction two to three years before—a warning sign ignored by their general practitioners.

It is well known that erectile dysfunction (a symptom of vascular disease in the smaller arteries) doubles the risk of heart disease, a risk equivalent to being a moderate smoker or having an immediate family history of heart disease. Erectile dysfunction in type 2 diabetes has been shown to be a better predictor of the risk of heart disease than high blood pressure or high cholesterol.

But despite this considerable evidence erectile dysfunction is still treated as a recreational or "lifestyle issue" rather than a predictor of a serious health problem, says Hackett.

The UK government has pledged to reduce the death rate from coronary heart disease and stroke and related diseases in people under 75 by at least 40% by 2010, yet there is no screening for erectile dysfunction in patients with diabetes or heart disease, he says.

"Continuing to ignore these issues on the basis that cardiologists feel uncomfortable mentioning the word 'erection' to their patients or that they may have to deal with the management of a positive response, is no longer acceptable and possibly, based on current evidence, clinically negligent", he concludes.

Source: Science Daily

Newest Hypertension Drugs May Improve Sexual Function

Sexual dysfunction in men with high blood pressure may be aided by the newest type of hypertension drug, reported Carlos Ferrario, M.D., of Wake Forest University Baptist Medical Center (WFUBMC), today at the American Heart Association's annual conference.

After 12 weeks of treatment with the new drug losartan, 88 percent of hypertensive males with sexual dysfunction reported improvement in at least one area of sexuality. The number of men reporting impotence dropped from 75.3 percent to 11.8 percent.

"These results suggest a possible solution for people who've stopped taking blood pressure medicines because they interfere with sexual function," said Ferrario director of WFUBMC's Hypertension and Vascular Disease Center. "In addition to controlling blood pressure as well or better than other medications, losartan seems to have a positive effect on sexuality."

The study was conducted in Spain by Ferrario and colleagues at the University of Valencia School of Medicine and Hospital Marina Alta. It used a self-administered questionnaire to screen 323 men and women with hypertension for sexual dysfunction, which includes decreased libido, impotence, and poor sexual satisfaction. Sexual dysfunction was diagnosed in 82 men, a prevalence of 42 percent.

These 82 men were compared to an equal number of men without sexual dysfunction. Both groups took 50 to 100 milligrams of losartan (sold under the brand name of Cozaar) daily for 12 weeks. They completed the questionnaire at both the beginning and end of the treatment period.

In the men with sexual dysfunction, 88 percent reported improvement in at least one area of sexual function after treatment with losartan. The number reporting overall sexual satisfaction increased from 7.3 percent to 58.5 percent. The number reporting a high frequency (at least once a week) of sexual activity improved from 40.5 percent to 62.3 percent. An improved quality of life was reported by 73.7 percent of the men with sexual dysfunction.

Similar results were reported in a small group of women treated with losartan. The sample size, however, was too small for the results to be statistically validated.

In the group of men without sexual dysfunction, the drug treatment produced no changes in sexual function or satisfaction.

Ferrario said the results are promising and point to the need for additional research.

"This study was performed in a non-random sample, so we must be careful in extrapolating the findings to the general hypertensive population," said Ferrario. "However, the consistent nature of the findings points out the need for larger clinical trials on this subject."

In the study, losartan was equal to or better than other drugs at controlling blood pressure. Losartan works by blocking angiotensin, a hormone that causes high blood pressure, and keeping it from binding to body tissues.

"Our finding that impotence improved in men taking losartan supports the theory that angiotensin contributes to sexual dysfunction," said Ferrario. "This helps debunk the myth that impotence is caused by hypertension drugs. In fact, it appears that sexual dysfunction is part of the hypertension disease process. Certain drugs, such as beta blockers and diuretics, can aggravate sexual dysfunction, but we don't believe they cause it."

Ferrario said losartan may improve sexual function and satisfaction in two ways: by acting on blood vessels in the penis that have been damaged by high blood pressure and by acting in the brain to improve well-being.

"Aside from its vascular effects, losartan may affect the central nervous system," said Ferrario. "This suggestion comes from findings that sexual satisfaction improved even in men who had reported having sex once a day."

The research was funded by an unrestricted educational grant from Merck Sharp & Dohme Spain to the Spanish investigators.

Source: Science Daily

Premature Ejaculation May Be A Genetic Disorder

Premature ejaculation can be embarrassing, but a new study suggests that it might be a genetic disorder.

Researchers from Turku, Finland, interviewed more than three thousand men - all pairs of male twins and their older or younger brothers - about the first time they had sex. Many participants in the study reported that they had suffered from erectile dysfunction and premature ejaculation at their first sexual encounter.

These common problems are often attributed to external factors, such as intoxication or nervousness due to peer pressure. This research confirms that such factors do cause erectile dysfunction. On the other hand, premature ejaculation appears to be strongly linked to genetic factors, and is not just psychological.

In an earlier study, researchers in The Netherlands linked premature ejaculation to a gene for serotonin regulation in a group of two hundred men. The new data from Finland independently show a genetic link to premature ejaculation in a much larger group, and rule out environmental factors.

Faculty of 1000 Medicine member David Goldmeier notes that the increasing evidence for a genetic cause of premature ejaculation opens the way for the development of new drug treatments - something that many men might benefit from. However, both Goldmeier and reviewer Taylor Segraves emphasize that drug therapy is not the only solution: psychotherapy will continue to be a valuable and useful form of treatment for sexual dysfunctions - even those with a genetic cause.

The study by Pekka Santtila, Kenneth Sandnabba and Patrick Jern was published in the Journal of Sex & Marital Therapy in March 2009.

Source: Science Daily

Sexual Competition Drives Evolution Of A Sex-related Gene

In what could be termed a truly seminal discovery, researchers have shown that when females are more promiscuous, males have to work harder -- at the genetic level, that is. More specifically, they determined that a protein controlling semen viscosity evolves more rapidly in primate species with promiscuous females than in monogamous species. The finding demonstrates that sexual competition among males is evident at the molecular level, as well as at behavioral and physiological levels.

The researchers, led by Howard Hughes Medical Institute investigator Bruce Lahn at the University of Chicago, published their findings in the November 7, 2004, issue of Nature Genetics.

Lahn's group studied semenogelin, a major protein in the seminal fluid that controls the viscosity of semen immediately following ejaculation. In some species of primates, it allows semen to remain quite liquid after ejaculation, but in others, semenogelin molecules chemically crosslink with one another, increasing the viscosity of semen. In some extreme cases, semenogelin's effects on viscosity are so strong that the semen becomes a solid plug in the vagina. According to Lahn, such plugs might serve as a sort of molecular "chastity belt" to prevent fertilization by the sperm of subsequent suitors, though they might also prevent semen backflow to increase the likelihood of fertilization.

Lahn and his colleagues compared the SEMG2 gene, which contains the blueprint for semenogelin, from a variety of primates. They began by sequencing the SEMG2 gene in humans, chimpanzees, pygmy chimpanzees, gorillas, orangutans, gibbons, macaques, colobus monkeys, and spider monkeys. These species were chosen because they represent all the major mating systems, including those in which one female copulates with one male in a fertile period (such as gorillas and gibbons); those in which females copulate highly promiscuously (such as chimpanzees and macaques); and those in which mating practices fall somewhere in between (such as orangutans where a female will copulate with the dominant male, but may also copulate with other males opportunistically).

"When we plotted data on the evolution rate of the semenogelin protein against the level of female promiscuity, we saw a clear correlation whereby species with more promiscuous females showed much higher rates of protein evolution than species with more monogamous females," said Lahn. The researchers measured protein evolution rates by counting the number of amino acid changes in the protein, then scaling it to the amount of evolutionary time taken to make those changes.

"The idea is that in species with promiscuous females, there's more selective pressure for the male to make his semen more competitive. It's similar to the pressures of a competitive marketplace. In such a marketplace, competitors have to constantly change their products to make them better, to give them an edge over their rivals -- whereas, in a monopoly, there's no incentive to change."

The finding constitutes the first specific evidence that different levels of sexual competition produce different genetic effects, said Lahn. It had been established previously that levels of polyandry -- the mating of one female with more than one male -- affected physiological traits. For example, more polyandrous species have larger testes capable of producing more sperm. There is a metabolic cost to such adaptation, Lahn said, and in species where there is no competition, the cost is not worth the effort.

"Now, for the first time, we show such competitive effects, not only at the level of physiology, but of individual genes," said Lahn. "The genes have to adapt faster for any given male to gain an edge over his competitors."

According to Lahn, while other studies have indicated that male reproductive genes in general tend to evolve more rapidly than other genes, "this study extends those observations to a more quantitative level, showing that the rate of evolution actually correlates with how intense the sexual selection is."

Source: Science Daily

Sex Really Does Get Better With Age (Just Ask A 70 Year Old)

An increasing number of 70 year olds are having good sex and more often, and women in this age group are particularly satisfied with their sex lives, according to a study published on the British Medical Journal website.

Knowledge about sexual behaviour in older people (70 year olds) is limited and mainly focuses on sexual problems, less is known about "normal" sexual behaviour in this age group.

Nils Beckman and colleagues from the University of Gothenburg in Sweden, studied attitudes to sex in later life among four representative population samples of 70 year olds in Sweden, who they interviewed in 1971-2, 1976-7, 1992-3, and 2000-1. In total, over 1 500 people aged 70 years were interviewed about different aspects of their sex lives including sexual dysfunctions, marital satisfaction and sexual activity.

The authors found that over the thirty year period the number of 70 year olds of both sexes reporting sexual intercourse increased: married men from 52% to 68%, married women from 38% to 56%, unmarried men from 30% to 54%, and unmarried women from 0.8% to 12%.

In addition, the number of women reporting high sexual satisfaction increased, more women reported having an orgasm during sex and fewer reported never having had an orgasm.

While the proportion of women reporting low satisfaction with their sex lives decreased, the proportion of men reporting low satisfaction increased. The authors suggest that this might be because it is now more acceptable for men to admit "failure" in sexual matters.

They also note that the number of men reporting erectile dysfunction deceased, whereas the proportion reporting ejaculation dysfunction increased, but the proportion reporting premature ejaculation did not change.

Interestingly, both men and women blame men when sexual intercourse stops between them. This finding replicates the results of other studies in the 1950s and 2005-06.

"Our study...shows that most elderly people consider sexual activity and associated feelings a natural part of later life", they conclude.

These findings emphasise the important and positive part sex plays in the lives of 70 year olds and is a welcome contribution to the limited literature about sexual behaviour in older people, writes Professor Peggy Kleinplatz from the University of Ottawa in Canada.

It will hopefully highlight the need for doctors to be trained to ask all patients, regardless of age, about their sexual concerns, she adds.

Source: Science Daily

Sperm Counts Unchanged Over 50 Years

Although many American men have at least one type of abnormality in their sperm, they are just as virile as their grandfathers, researchers at the Keck School of Medicine of the University of Southern California have found. In fact, their sperm densities were no different from samples collected in major studies in the 1950s.

"Everything in our study indicates that the average man's sperm count is not changing," said study co-author Rebecca Sokol, M.D., of the Keck School of Medicine of USC. The results are published in the March issue of the journal Fertility and Sterility.

Sokol and her colleagues looked at semen samples collected from 1,385 men at LAC+USC Medical Center over a three-year period between 1994 and 1997. At the time samples were taken, the men were partners of women who were seeking infertility treatment.

Examining total sperm counts and semen abnormalities, the investigators found that of the half who showed some sperm abnormality, based on World Health Organization criteria, 52% had sperm that were borderline low in mortality; 18% had abnormal sperm concentration, and 14% had abnormally shaped sperm.

Previous studies popularized in the press claimed that male sperm counts were declining because of everything from pollution to sedentary jobs to tight underwear - and even spending too long in the car.

Sokol said this new study was both large and well designed, so that the results can be trusted to be an accurate reflection of sperm quality among American men. She noted that, coincidentally, the pool of men who provided semen samples primarily worked in blue-collar jobs that could have exposed them to significant environmental toxins - so if a drop was found and if pollutants were the cause, it would have been likely to be represented in the findings. Sokol and her colleagues nevertheless found that values for the average sperm count were identical to the count reported in the 1950s.

Source: Science Daily

Testosterone Deficiency Relatively Rare In Men

A new study reveals that relatively few men, only 5.6 percent of the male population, actually suffer from low testosterone accompanied by clinical symptoms. That percentage, however, rises substantially with age.

Low testosterone levels are typically defined as less than 300 ng/dL (nanograms per deciliter) of total testosterone and less than 5 ng/dL of free testosterone. Free testosterone is the amount of the hormone unbound to other proteins and is “free” to work inside the body. “Low levels of testosterone impact many aspects of male physiology,” said Andre B. Araujo, Ph.D., a research scientist at the New England Research Institutes in Watertown, Mass., and lead author of the study. “This is particularly significant because the ongoing aging of the U.S. male population is likely to cause the number of men suffering from androgen deficiency to increase appreciably.”

Consistent with a recently issued Clinical Practice Guideline from the Endocrine Society, symptomatic androgen deficiency in the study by Araujo and colleagues is defined as low total and free testosterone plus the presence of low libido, erectile dysfunction, osteoporosis or facture, or two or more of the following symptoms: sleep disturbance, depressed mood, lethargy, or diminished physical performance.

For this study, the researchers analyzed data on 1,475 randomly selected men enrolled in the Boston Area Community Health (BACH) Survey. The survey tracked subjects between the ages of 30-79 and compiled complete data on factors such as testosterone, symptoms of hormone deficiency, and medications that may impact sex hormone levels. Among all men in the study (mean age 47.3 plus-or-minus 12.5 years), approximately 24 percent had low total testosterone and 11 percent had low levels of free testosterone. Interestingly, while low testosterone levels were associated with symptoms, many men with low testosterone levels were asymptomatic (e.g., among men aged 50 years and older 47.6 percent were asymptomatic).

“Since these men would not likely come to clinical attention,” said Araujo, “it may be important to determine whether there are clinical risks to missing these asymptomatic men with low testosterone levels.” Overall, only 5.6 percent of men in the study had symptomatic androgen deficiency. For those men in the upper range of ages in the study (70 years or older), however, the percentage increased to 18.4 percent.

The researchers predicted that by the year 2025 there may be as many as 6.5 million American men 30-79 years of age with symptomatic androgen deficiency, an increase of 38 percent from year 2000 population estimates.

“This study did not assess whether men with symptomatic androgen deficiency are good candidates for testosterone therapy,” said Araujo. “Well designed randomized placebo-controlled trials would be needed to address the risks and benefits of testosterone therapy.”

The BACH Survey was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (Grant DK 56842). Analyses for the current study were supported through an unrestricted educational grant from GlaxoSmithKline.

A rapid release version of this paper has been published on-line and will appear in the November 2007 issue of the Journal of Clinical Endocrinology & Metabolism, a publication of The Endocrine Society.

Source: Science Daily