The objective of this study was to validate the Malay version of the International Index of Erectile Function (IIEF-15) in patients with lower urinary tract symptoms. Reliability and validity was assessed by using the test-retest while Cronbach's alpha was used to assess internal consistency. Effect size 5was evaluated to assess the sensitivity to change in the pre-transurethral resection of the prostate (TURP) vs post-TURP. Internal consistency was excellent. A high degree of internal consistency was observed for each of the 15 items and five domains (Cronbach's alpha value=0.56 and higher and 0.74 and higher, respectively). Test-retest correlation coefficient for the 15 items and domains scores showed no significant changes. Intraclass correlation coefficient for 15 items and domains were high (ICC=0.59 and above). It can be concluded that the Mal-IIEF-15 is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.
Our study aimed to assess the methodological strengths and weaknesses of erectile dysfunction clinical practice guidelines (CPGs) for individuals using the AGREE II tool. Erectile dysfunction related CPGs were identified from three databases: the National Guideline Clearinghouse, the Guidelines International Network, and PubMed between 2000 and 2020. We designed an independent assessment for each of the erectile dysfunction related CPGs using the AGREE II tool. Four appraisers performed these assessments. The literature search identified 8 CPGs that met our inclusion criteria. The evaluation of the AGREE II domains of each individual revealed that the median scores of domains related to applicability were quite low (39%). Also, the median scores of domains related to the rigour of development and the stakeholder involvement were relatively low (53% and 63%). We determined the highest median scores in three AGREE II domains: clarity of presentation (80.5%), editorial independence (77%), and scope and purpose (89.5%). We found that the European Association of Urology (EAU), the American Urological Association (AUA), and the British Society for Sexual Medicine (BSSM) guidelines had >60% in >4 domains and that their average AGREE II scores were over 70%. In the Canadian Diabetic Association (CDA) and the Japanese Society for Sexual Medicine (JSSM) guidelines, we found that >4 domains were >60%, but their average AGREE II scores were below 70%. The British Medical Journal (BMJ), the Canadian Urologic Association (CUA), and the Malaysian Urologic Association (MUA) guidelines had >60% in <3 domains. We highly recommended EAU, AUA and BSSM guidelines, while we moderately recommended CDA and JSSM guidelines. BMJ, CUA and MUA guidelines were weakly recommended. The quality of the guidelines for erectile dysfunction was variable according to AGREE II. We noted significant deficiencies in the methodological quality of the CPGs developed by different organisations in the areas of applicability and rigour of development.
The objective of this study was to explore the roles and perceptions of general practitioners (GPs) in the management of erectile dysfunction (ED). This qualitative study used focus group discussions and in-depth interviews. This study was conducted based on 28 GPs from an urban area in Malaysia who had managed patients with ED and prescribed anti-ED drugs. Main outcome measures included the roles of GPs in managing patients with ED (active or passive), perceptions regarding ED and the treatment, and factors influencing their decision to prescribe. Majority of the GPs assumed a passive role when managing patients with ED. This was partly due to their perception of the disease being nonserious. Some also perceived ED as mainly psychological in nature. The anti-ED drugs were often viewed as a lifestyle drug with potentially serious side effects. The fear of being perceived by patients as 'pushing' for the drug and being blamed if the patients were to develop serious side effects also hampered the management of this disease. GPs who participated in this study remained passive in identifying and treating patients with ED and this was attributed to their perception of the disease, drug treatment and patient's background.
We adapted the English International Index of Erectile Function (IIEF) into Malay. This was difficult as many sex-related terms do not exist in colloquial Malay. In the pretest, there was no difficulty with comprehension and all subjects judged the Malay IIEF equivalent to the English IIEF. After slight modification, a final instrument was evaluated in two studies. Study A included 136 subjects. It showed that the instrument had good reliability and discriminant validity. The factor structure of the English IIEF was not reproducible. Study B included 26 ED subjects who underwent oral sildenafil therapy. The Malay IIEF was sensitive to treatment response. The area under the ROC curve of the Malay IIEF-5 was 0.86; the optimal cutoff score has a sensitivity of 85% and specificity of 75%. The results suggest that the Malay IIEF requires more work, but the Malay IIEF-5 has acceptable measurement properties to recommend its use in clinical practice and research.
Methadone maintenance treatment is proven to be effective treatment for opioid dependence. Of the many adverse events reported, sexual dysfunction is one of the most common side effects. However, there may be other clinical factors that are associated with sexual dysfunction among methadone users. We conducted a meta-analysis to examine the clinical factors associated with sexual dysfunction among male patients on methadone and buprenorphine treatments, of which eligible studies were selected using prior defined criteria. A total of 2619 participants from 16 eligible studies, published from inception till December 2012, were identified from the PubMed, OVID and EMBASE databases. The included studies provided prevalence estimates for sexual dysfunction among methadone users with a meta-analytical pooled prevalence of 52% (95% confidence interval (CI), 0.39-0.65). Only four studies compared sexual dysfunction between the two groups, with a significantly higher combined odds ratio in the methadone group (odds ratio=4.01, 95% CI, 1.52-10.55, P=0.0049). Our study shows that eight clinical factors are associated with sexual dysfunction among men receiving opioid substitution treatment, namely age, hormone assays, duration of treatment, methadone dose, medical status, psychiatric illness, other current substance use and familial status, and methadone versus buprenorphine treatment. Despite the methodological limitations, the findings of this meta-analysis study may offer better insights to clinicians in dealing with both sexual dysfunction and its related problems.
OBJECTIVES:
To explore by a pooled subanalysis of the Global Better Sex Survey sexual aspirations and unmet needs of men and women from Hong Kong, Indonesia, Japan, Malaysia, Singapore, South Korea, Taiwan, and Thailand.
METHODS:
To qualify, respondents must have had sexual intercourse at least once in the past 12 months. Women must have had heterosexual intercourse. Data were weighted by population size between countries.
RESULTS:
Of 3538 Asian respondents (1776 men and 1762 women), 52% were aged <40 years, 40% were aged 40-59 years, and 8% were aged >or=60 years. The majority were married or in a relationship. Men and women reported having sexual intercourse 5.1 and 4.0 times monthly, respectively. Attraction to partner, foreplay, intercourse, and achieving orgasm were important to most men and women. Two thirds were less than very satisfied with their sex life, and 36% of men were interested in improving sex. For a good sexual experience, the man's ability to get and maintain an erection and erection hardness were important to the majority of Asian men and women. Few respondents reported using a prescription erectile dysfunction medication, but many showed interest in using these medications to improve their sex lives. A comparison between individual countries suggests that attitudes about sex differ from country to country, and between men and women in each country.
CONCLUSIONS:
Sex is very important to Asian men and women, but many of them are not fully satisfied with their sex lives and want to improve them.
Sildenafil citrate (Viagra), a selective inhibitor of cGMP-specific phosphodiesterase type-5, has been used as an oral therapeutic drug for erectile dysfunction. The present paper is a clinical study of the success rate and side-effects of the use of sildenafil in a multi-racial population in Singapore.
Objectives: Undiagnosed glycaemic disorders remain a major health concern as in such cases the opportunity for early interventions that can potentially prevent complications is missed. Erectile dysfunction (ED) has been suggested as a predictor for glycaemic disorders in men. However, data on men with ED having undiagnosed glycaemic disorders is limited, especially in the Malaysian context. This study aimed to identify prevalence and associated factors of undiagnosed glycaemic disorders in men with ED.
Methods: We applied a cross-sectional purposive sampling technique on a group of 114 men with ED without underlying glycaemic disorders. They underwent a 2-h oral glucose tolerance test and the cases were then classified into two groups: normal and undiagnosed glycaemic disorders groups. The glycaemic disorders group consisted of patients with diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG). The patients were interviewed, and their medical records were reviewed for their sociodemographic and clinical profiles.
Results: Prevalence of undiagnosed glycaemic disorders in men with ED was 41.2%. Higher age (adjusted OR = 1.10, 95% CI: 1.03, 1.17, p = 0.002) and BMI (adjusted OR = 1.16, 95% CI: 1.05, 1.29, p = 0.003) were found to be significantly associated with undiagnosed glycaemic disorders.
Conclusion: This study found that men with ED had a high prevalence of undiagnosed glycaemic disorders. ED was associated with advancing age and higher BMI. Further research to validate the findings of this study is needed to increase the prevalence of DM screening among men with ED.
Study site: Klinik Kesihatan Kajang, Selangor, Malaysia
Objectives: This study aimed to determine the prevalence of premature ejaculation and its associated factors among men attending a primary healthcare clinic in Kota Bharu, Kelantan, Malaysia.
Methods: A cross-sectional study was conducted on 18- to 60-year-old sexually active men during at least the past 6 months. Patients with unstable psychiatric illnesses, mental retardation, and illiteracy were excluded. A questionnaire on sociodemographic factors, Malay version Premature Ejaculation Diagnostic Tool, and Malay version International Index Erectile Function-5 were distributed. Premature ejaculation was defined as a Premature Ejaculation Diagnostic Tool score of 9 and above. Descriptive analysis and simple and multiple logistic regression analyses were performed using SPSS version 22.
Results: A total of 294 of 313 eligible men responded, with a response rate of 93.9%. The prevalence of premature ejaculation was 21.4% (n = 63). The multiple logistic regression analysis showed that mild [adj. OR (95% CI): 5.6 (1.89, 16.91); P = 0.002], mild-moderate [adj. OR (95% CI): 8.2 (2.72, 24.46); P
OBJECTIVES: Erectile dysfunction (ED) is a problem commonly encountered by patients on methadone maintenance therapy (MMT). This study aimed to assess the prevalence of ED among this group of patients along with its risk factors and association with quality of life (QOL).
METHODS: Male patients on MMT in a tertiary hospital in Malaysia were included in the study. A total of 134 patients with sexual partners were assessed for ED using the International Index of Erectile Function. Patients were assessed for substance use using Opiate Treatment Index (OTI) and depression using the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM). QOL was evaluated using World Health Organisation Quality of Life (WHOQOL)-BREF.
RESULTS: The prevalence of ED among patients on MMT was 67%, with 26.1% having mild ED, 30.4% having mild-to-moderate ED, 7.0% having moderate ED, and 17.2% having severe ED. Patients with depression were 4 times more likely to have ED compared with patients without depression, whereas increasing age significantly correlated with the severity of ED. Having ED predicted a poorer QOL in the social relationships domain.
CONCLUSION: Depression is highly associated with ED, which negatively influences the social aspect of QOL among patients on methadone maintenance therapy.
Study site: outpatient addiction psychiatric clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
BACKGROUND:
Depression and erectile dysfunction (ED) have a complex and bi-directional relationship. We examined the relationships between erectile dysfunction and depressive symptoms or diagnosed depression, sexual activity and sexual satisfaction.
METHODS:
A population survey of men aged 40-70 years was carried out in Brazil, Italy, Japan and Malaysia in 1997-1998. A questionnaire was used to collect life style, sexual behaviors and medical data. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. ED was classified as moderate or complete if the men reported they were "sometimes" or "never" able to achieve and maintain an erection satisfactory for sexual intercourse. Only men with a sexual partner and not taking psychoactive drugs were considered.
RESULTS:
Diagnosed depression was reported by 2.0% of the men, depressive symptoms by 21.0%. The prevalence of moderate or complete ED was 17.8%. Sexual satisfaction related to the frequency of sexual intercourse and inversely related to depressive symptoms. Depressive symptoms were positively associated with being single (odds ratio [OR] 1.7), widowed, separated or divorced (OR 2.2), moderate or complete ED (1.8), heart disease (1.6) and smoking (1.6), and negatively associated with age, physical activity and frequency of sexual intercourse.
LIMITATIONS:
Cross-sectional studies cannot establish a temporal cause-effect relationship. However, the confirmation of known associations reassures about the validity of the original findings.
CONCLUSIONS:
The findings suggest that depressive symptoms are linked to ED by the mediation of decreased sexual activity and the dissatisfaction generated by the inability to have a healthy sexual life.
Ample evidence strongly supports the fact that periodontal disease is a major risk factor for various systemic diseases namely cardio-vascular disease, diabetes mellitus, etc. Recently, investigators focussed on exploring the link between chronic periodontitis (CP) and erectile dysfunction (ED) by contributing to the endothelial dysfunction. Both the diseases share common risk factors. Various studies conducted in different parts of the world in recent years reported the evidence linking this relationship as well as improvement in ED with periodontal treatment. Systemic exposure to the periodontal pathogen and periodontal infection-induced systemic inflammation was thought to associate with these conditions. The objective of this review was to highlight the evidence of the link between CP and ED and the importance of oral health in preventing the systemic conditions.
BACKGROUND:
Smoking is a major public health problem, especially in Iraq. There is very little information had been documented regarding smoking risk factors and quit intention among Iraqi smokers.
OBJECTIVES:
The main objectives of this study are to determine smokers' knowledge and perception about smoking health risks; and to determine smoking behavior and quitting intentions among Iraqi smokers; as well as to predict the factors that may associate with quit intentions.
METHODS:
A cross-sectional study was conducted at the outpatient clinic in Tikrit Teaching Hospital, Tikrit City, Iraq. Adult smokers who are smoking cigarette everyday and able to communicate with the researcher were invited to participate in the study. A self-administered questionnaire was used to collect data from 386 participants.
RESULTS:
This study showed that smokers had low awareness about some risk effects of smoking such as lung cancer in nonsmokers (30.1%), impotence in male smokers (52.6%), premature ageing (64%), and stroke (66.3%). In addition, the high score of knowledge and perception was significantly associated with quitting intention.
CONCLUSION:
Smokers' knowledge and perception regarding smoking health effects were low, especially in terms of secondhand smokers. Many efforts needed from health policy-makers and health care professionals to disseminate information about the risks of smoking and health benefits of give up smoking.
KEYWORDS:
Health risks; knowledge; perception; quit intentions; smoking
Despite the rise in recreational use of ketamine in Malaysia, there have been no studies of users or of the health-related consequences they face. This study was initiated to examine ketamine use and its health consequences. A structured questionnaire was used to elicit information. A final sample of 127 males was divided into persons who used only ketamine and those who were poly-drug users. Each group was further divided into long-period and short-period users. Urine toxicology screening for ketamine and other illicit drugs commonly used in Malaysia was also done. Our findings corroborate those of earlier studies that link ketamine use to urological problems such as frequent urination, dysuria, incontinence, painful bladder, nocturia, and urinary urgency. A new finding in this study is the significant association between ketamine use and erectile dysfunction, such that higher odds of reporting erectile dysfunction were linked to long-period users. Our findings strengthen the case for early intervention, as ketamine users are drawn from young and unmarried male participants. The association of ketamine use with erectile dysfunction, if substantiated, will help physicians in their diagnosis of erectile dysfunction, particularly among youths.
OBJECTIVE:
Assess the effectiveness of sildenafil in Asian males with erectile dysfunction (ED) and one or more of the co-morbidities, mild-to-moderate hypertension, dyslipidemia, and diabetes.
MATERIAL AND METHOD:
A six-week, double-blind, randomized, placebo-controlled, multicenter study was carried out in Thailand, Malaysia and Singapore. One hundred and fifty five male subjects were randomized (2:1) to sildenafil (n = 104) or placebo (n = 51). Sildenafil was started at 50 mg and increased (100 mg) or decreased (25 mg) at week 2 if necessary.
RESULTS:
On the primary efficacy endpoint, sildenafil-treated subjects had significantly better scores on the International Index of Erectile Function (IIEF) questions 3 and 4 than placebo (p < 0.001, both questions). When accumulated into IIEF domains, all five domains were significant in favor of sildenafil. In addition, sildenafil-treated subjects were more satisfied with treatment and had a higher intercourse success rate. The majority of adverse events were mild in severity; the most commonly reported treatment-related events were dizziness (7.7%) and tinnitus (2.9%).
CONCLUSION:
Sildenafil (25, 50, and 100 mg) was found to be an effective, safe, and well-tolerated treatment for ED in the present study population of Thai, Malaysian, and Singaporean males who also had increased cardiovascular risk.