Recent Publications by CFE Educators

INTRODUCTION

Individuals who engage in regular sexual intercourse are more likely to report good overall quality of life. Studies of sexuality in adolescents have focused on high-risk behaviors whereas similar studies in older adults have focused on sexual dysfunction. Given a paucity of data on the sexual behaviors of young adults and the possibility of important relationships between sexuality and overall health, we sought to determine factors that influence the frequency of intercourse in adult men and women in the United States.

AIM

To identify factors related to coital frequency in young and middle-aged adults.

METHODS

We analyzed data from the male and female sample of the 2002 National Survey of Family Growth to examine frequency of sexual intercourse among Americans aged 25-45 years (men: N = 2,469; women: N = 5,120).

MAIN OUTCOME MEASURES

Multivariable negative binomial regression modeling was used to test for independent associations between the frequency of sexual intercourse and demographic, socioeconomic, and anthropometric variables.

RESULTS

In this study, men and women between the ages of 25 and 45 have sex a mean 5.7 and 6.4 times per month, respectively. Being married significantly increased coital frequency for women but has no effect on male coital frequency. Increased height, less than high school education, and younger age were predictive of increased sexual frequency in men. Pregnancy was associated with significantly lower coital frequency for both men and women. No association was shown between self-reported health status and coital frequency on multivariable analysis.

CONCLUSIONS

Among young male adults, coital frequency is associated with specific socioeconomic, demographic, and anthropomorphic characteristics. Sexual frequency in women does not appear to be influenced by such factors. Self-reported health is not predictive of sexual activity in this age group.

To meet the medical, dental, and psychologic needs of the individual with a complex craniofacial birth defect such as cleft lip and palate, a team of specialists must be involved. The currently accepted standards of care can only be met if the appropriate specialists work together in the diagnostic workup and in the immediate and long-term planning and execution of the various treatment modalities required. This concept is clearly stated in the "Parameters" document published by the American Cleft Palate-Craniofacial Association in 2004 (Cleft Palate Craniofac J 1993;30[Suppl]:S1-16).Not only does the interdisciplinary team care provide the best overall outcomes for the patient but also is the most efficacious and cost-effective way of meeting the goals of treatment. Interdisciplinary cleft team members should also be a resource in educating parents, students, and other health care providers and may be participants in research on prevention, interception, or regeneration. We present in this article the protocols and treatment outcomes of the University of California at San Francisco.

The quartz crystal microbalance (QCM) was used to monitor the immobilization of tyrosinase on polycationic and polyanionic precursor assemblies in situ and in real-time. The resulting enzymatic surfaces were then exposed to various flavonoids, and the degree of binding was measured using QCM. We show that enzyme activity is retained when immobilized on polycationic films (flavonoid binding observed), while the active site is blocked when assembled on a polyanionic film (no flavonoid binding to the enzyme). We rationalize these observations by considering a combination of interlayer interpenetration and strong electrostatic interactions between the polyelectrolyte and tyrosinase's dicopper 2(+) center. Ion-pair formation between anionic moieties of the polyanion and the metal-coordinated active site is suggested as the dominant mechanism leading to the deactivation of tyrosinase. We are currently working to expand this research to achieve a more general theory of how various metal-coordinated enzymes react with polyelectrolyte surfaces of varying structural morphology, charge density, and chemical composition.

INTRODUCTION

Highly selective inhibitors of phosphodiesterase type 5 (PDE5I) have been commercially available for over a decade. Our knowledge of these drugs continues to expand.

AIMS

To review recent (since 2007) developments on the utilization of PDE5I in clinical practice. The focus of this manuscript is on the use of PDE5I for sexual concerns. Also reviewed are recent reports of rare but potentially serious toxicity.

METHODS

Pubmed search utilizing the search terms "phosphodiesterase type 5 inhibitor," "PDE5 inhibitor,"sildenafil," "vardenafil," and "tadalafil." Articles were screened for their relevance to the clinical practice of sexual medicine and/or PDE5I toxicity. Publications on routine dose PDE5I for penile rehabilitation, lower urinary tract symptoms, and stuttering priapism are summarized in a separate manuscript in this series.

MAIN OUTCOME MEASURES

Peer-reviewed publications since the last major update on PDE5I published in the medical literature.

RESULTS

Recent investigations have suggested a number of interventions to potentially improve patient compliance with PDE5I therapy. Additionally, the approval in the past year of tadalafil as a daily medication signifies a potential paradigm shift in our concept of this disorder. Daily dosing may be useful in some men; however, the other available PDE5I continue to show excellent efficacy in the management of erectile dysfunction (ED). In addition to direct effects on ED, several recent reports highlight the use of PDE5I for improvement of premature ejaculation, sexual relationship status, and sexual function in women. There have also been several recent reports of rare but serious toxicity, particularly ototoxicity, associated with PDE5I use.

CONCLUSIONS

Recent studies have suggested new ways to optimize utilization of PDE5I not only for the management of ED but also for other sexual concerns in both men and women. Rare but serious toxicities have been reported with PDE5I and, therefore, judicious counseling is indicated before prescribing these medications.

The majority of percutaneous coronary interventions (PCIs) are carried out in nonurgent situations, primarily in patients with stable coronary artery disease. Recent trials have concluded that for patients with stable coronary artery disease, treatment with optimal medical therapy versus optimal medical therapy plus PCI yields equivalent outcomes in terms of morbidity and future risk of myocardial infarction. Since PCI is a procedure with risk, it is important to identify patients for whom the benefit of the procedure outweighs the harms. PCI may be beneficial in certain subgroups, such as patients with moderate-to-severe ischemia on noninvasive testing. Although current guidelines require documentation of ischemia prior to elective PCI and this strategy is cost effective, pre-PCI stress testing appears to be underutilized, potentially leading to PCI being performed in patients who may not derive benefit from the procedure.

INTRODUCTION

Ultrasonography of the penis is readily available to the urologist and gives good anatomic detail of soft tissue structures. It has not been widely utilized in the assessment of Peyronie's disease (PD).

AIMS

To describe the sonographic characteristics of the penis in PD and the relationship between clinical and sonographic features.

METHODS

This cross-sectional study enrolled patients from a single clinical practice. A PD-specific questionnaire was administered and sonographic evaluations were performed.

MAIN OUTCOME MEASURES

Sonographic characteristics of men with PD.

RESULTS

Tunical thickening, calcifications, septal fibrosis, and intracavernosal fibrosis, were observed at initial clinical evaluation in 50%, 31%, 20%, and 15% of men, respectively. Men aged 40-49 (OR 2.4, P = 0.02) and men aged 50-59 (OR 2.4, P = 0.004) were more likely to have sub-tunical calcifications relative to men under age 40. Men with septal fibrosis had fewer chronic medical conditions such as diabetes (OR 0.3, P = 0.04), hypertension (OR 0.5, P = 0.03), and coronary artery disease (OR 0.2, P = 0.05), and presented within 1 year of disease onset (OR 2.1, P = 0.001). Men with septal fibrosis were less likely to have lost penile length (OR 0.5, P = 0.04) and more likely to be able to have intercourse (OR 1.9, P = 0.05). Men with intracavernosal fibrosis were less likely to have penile pain (OR 0.5, P = 0.05), but more likely to have penetration difficulty during intercourse (OR 1.9, P = 0.008), an additional penile deformity (OR 1.8, P = 0.02), or rapid onset of disease (OR 1.7, P = 0.04). Tunical thickening was associated with a decreased ability to have intercourse (OR 2.3, P 0.001).

CONCLUSION

PD is a clinically and sonographically heterogeneous condition. Sonography is a safe, low-cost, and rapid means of objectively characterizing lesions in this condition. This may help track the evolution of the condition in individual patients and in the future may be useful for tailoring treatment strategies.