Risk Factors of Sexual Dysfunction

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Risk Factors
There are common risk factor categories associated with sexual dysfunction for men and women which include the following: general health status of the individual, the presence of diabetes mellitus, the presence of cardiovascular disease, concurrence of other genitourinary disease, psychiatric/psychological disorders, other chronic diseases, and socio-demographic conditions. For erectile dysfunction, smoking and hormonal factors also serve as well-defined risk factor associated conditions. There is also evidence-based literature for medication-related association for erectile dysfunction. Evidence-based criteria should be established for evaluating risk factors for women’s and men’s sexual dysfunctions. A good source of this type of critical analysis is that provided in reference [11]. This particular paper describes weaknesses in review of articles published on the association between diabetes mellitus and erectile dysfunction. The association between smoking and other tobacco use and erectile dysfunction was examined with the following conclusion. At the present time, after careful scrutiny against specific selection criteria, it appears that the preponderance of evidence available would identify cigarette smoking as an independence risk factor for ED. It is possible that this view may change in the future as more evidence becomes available. However, for the present, cigarette smoking should be considered a risk factor for erectile dysfunction. On the other hand, we have not identified descriptive or analytical literature which links smoking to other male sexual dysfunctions or to any female sexual dysfunction. It has been suggested in women that decreased lubrication is significantly (univariately) associated with being diabetic. Similarly, hypertension in women has been reported to be associated with decreased lubricative function and orgasmic dysfunction.

Stress urinary incontinence has been found by some authors to negatively influence all aspects of women’s sexual function (sexual interest, desire, arousal, lubrication, orgasm) and to be significantly correlated with dyspareunia and vaginismus. In women, a psychiatric disorder is closely associated with orgasmic dysfunction and dyspareunia. In men, diabetes has been associated with a greater prevalence of decreased desire and orgasmic dysfunction as well as erectile dysfunction. For men with insulin-dependent diabetes mellitus, diabetes present for over 10 years, with fair or poor control based on glycosylated hemoglobin, and those managed with agents other than diet control, history of diabetes mellitus related arterial, renal, or retinal disease and neuropathy, and those who are smokers all show a higher odds ratio for erectile dysfunction. Endothelial dysfunction is a condition present in many cases of erectile dysfunction and thus there are common etiological pathways for other vascular disease states.

Modification of risk factors has been reported essentially in only one longitudinal study and, other than increasing physical activity, other modifications of lifestyles do not seem to change incidence data, at least in the males who start to be followed well in to middle ages such as the middle 50s [10].

Corresponding Author: Ronald W. Lewis, Department of Urology, University of Augusta, Augusta, GA, USA. Tel: (706) 721-0985; Fax: (706) 721-2548; E-mail:

References
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Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B. Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impotence Research 2004, in press.

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–30.

Rosen RC, Brown C, Heiman J, Leiblum SR, Meston C, Shabsigh R, Ferguson D, D’Agostino R.
The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000;26:191–208.

Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol 2000;163:460–3.

Moreira ED, Lbo CF, Diament A, Nicolosi A, Glasser DB. Incidence of erectile dysfunction in men 40 to 69 years old: results from a population-based cohort study in Brazil. Urology 2003;61: 431–6.

Schouten BWV, Bosch JLHR, Bernsen RMH, Blanker MH, Thomas S, Bohnen AM. Incidence of clinically relevant erectile dysfunction (ED) and ED by two other common definitions: strong effect of definition and bias by duration and follow-up. Submitted to Int JImpotence Res.

Fugl-Meyer KS, Lewis RW, Bosch R, Fugl-Meyer AR, Laumann EO, Lizza E, Martin-Morales A. Definitions, classification, and epidemiology of sexual dysfunction. In: Lue T, Giuliano F, Khoury S, Montorsi F, Rosen R, editors. Sexual medicine volume 1: sexual dysfunction in men health publications. United Kingdom; 2004:1–36.

Prins J, Blanker MH, Bohnen AM, Thomas S, Bosch JLHR. Prevalence of erectile dysfunction: a systematic review of population-based studies. Int J Impotence Res 2002;14:422–32.

Fugl-Meyer AR, Fugl-Meyer KS. Sexual disabilities are not singularities. Int J Imp Res 2002;14:487–93.

Weinhardt LS, Carey MP. Prevalence of erectile disorder among men with diabetes mellitus: comprehensive review, methodological critique, and suggestions for future research. J Sex Res 1996;33:205–13.

Derby CA, Mohr B, Goldstein I, Feldman HA, Johannes CB, McKinlay JB. Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology 2000;56:302–6.

Ronald W. Lewis, MD, Kersten S. Fugl-Meyer, PhD, R. Bosch, MD, Axel R. Fugl-Meyer, PhD,
Edward O. Laumann, PhD, E. Lizza, MD, and Antonio Martin-Morales, MD

Department of Urology, Medical College of Georgia, Augusta, GA, USA;
Sexology Unit, University Hospital, Upssala, Sweden;
Department of Urology, Academic Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands;
University of New York, NY, USA;
Department of Urology, Carlos Haya Hospital, Malaga, Spain Chicago, Chicago, IL, USA;

Summary of Committee. For the complete report please refer to Sexual Medicine: Sexual Dysfunctions in Men and Women, edited by T.F. Lue, R. Basson, R. Rosen, F. Giuliano, S. Khoury, and F. Montorsi, Health Publications, Paris 2004.

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