Condom, Erection-loss Study Identifies Possible Path To Risky Behavior
The loss of an erection during sex is more than disheartening. If associated with condom use, it can contribute to risky sexual behavior that could potentially harm both partners by exposing them to sexually transmitted infections.
Researchers at Indiana University's Kinsey Institute for Research in Sex, Gender and Reproduction found that men who reported erection loss in association with condom use also reported more unprotected intercourse with women and were less likely to use condoms consistently compared with men without condom-associated erection loss.
Nearly 40 percent of their study participants -- male patients at an STD clinic -- reported condom-associated erection loss at least once in the previous three months.
"Condom use is one of the most important behaviors that can reduce the spread of sexually transmitted infections," said Cynthia Graham, a research tutor on the Oxford Doctoral Course in Clinical Psychology and an associate research fellow at the Kinsey Institute. "This study has highlighted a difficulty -- loss of erection while using condoms -- that may make men more reluctant to use condoms. The findings have important implications for education and counseling efforts."
The study, which will appear in the upcoming November issue of Sexual Health, is part of an ongoing line of research at the Kinsey Institute into condom errors and problems, and is the first to evaluate erection problems associated with condom use.
Men were almost three times more likely to report erection loss if they were less confident about how to use condoms correctly, signaling the need for education on condom application. Men reporting problems with the "fit or feel" of condoms were about 2.2 times more likely to report erection loss compared with men not having these problems. The study authors suggest counseling and educational programs could make available a broader selection of condoms in terms of size and shape, as well as a selection of water-based lubricants.
Men who reported having sex with three or more partners in the past three months were almost twice as likely to report erection loss compared with men having fewer partners. These findings underline the importance of encouraging men to discuss condom use with new lovers.
The study involved 278 men ages 18 to 35 who visited an urban STD clinic in the Midwest between October 2004 and September 2005. The men all reported using a condom at least three times in the previous three months during intercourse with a woman. The men were asked about whether they had lost an erection during the sexual encounters and, if so, when it occurred (when the condom was put on or after sex had begun). The questionnaire also obtained information about whether condoms were removed during sex or not used at all and asked about possible problems, such as slippage or breakage and the ease in using them correctly.
Other key findings include:
-- Nearly three in 10 men (28.1 percent) reported that they had lost their erection while putting on a condom. This occurred once during the last three times they used a condom.
-- 13.4 percent reported they lost their erection once while using a condom during intercourse; 9.4 percent reported that this happened twice, and 3.6 percent reported that it happened all three times.
-- 17.3 percent reported losing an erection both while applying the condom and during sex.
-- Condoms were removed prematurely on at least one of the past three occasions by 40.8 percent of the men reporting erection loss, compared with 21.3 percent of men not reporting this problem.
-- Erection loss was more likely among men who reported at least one condom breakage (47.1 percent) compared with men not reporting breakage (32.5 percent).
The study coauthors are Richard Crosby, co-director of the IU-based Rural Center for AIDS/STD Prevention and professor at the College of Public Health at the University of Kentucky; William L. Yarber, a fellow of the Kinsey Institute for Research in Sex, Gender and Reproduction, senior director of RCAP and professor in IU Bloomington's Department of Applied Health Science and Department of Gender Studies; Stephanie A. Sanders, associate director of the Kinsey Institute, research fellow of RCAP and professor in the Department of Gender Studies; Kimberly McBride, a graduate student and researcher at the Kinsey Institute and Department of Applied Health Science; Robin R. Milhausen, assistant professor at the Social Justice and Sexual Health Research Lab, Department of Sociology and Anthropology, University of Windsor, Canada; and Janet N. Arno, affiliate of RCAP, associate professor at the Department of Infectious Diseases, IU School of Medicine, and co-director of RCAP.
The research was supported in part by the RCAP, which is a joint project of IU, the University of Colorado and the University of Kentucky, and by IU Bloomington's School of Health, Physical Education and Recreation.
"Erection loss in association with condom use among young men attending a public STI clinic: potential correlates and implications for risk behaviour," Sexual Health, 2006; 3(4).
Researchers at Indiana University's Kinsey Institute for Research in Sex, Gender and Reproduction found that men who reported erection loss in association with condom use also reported more unprotected intercourse with women and were less likely to use condoms consistently compared with men without condom-associated erection loss.
Nearly 40 percent of their study participants -- male patients at an STD clinic -- reported condom-associated erection loss at least once in the previous three months.
"Condom use is one of the most important behaviors that can reduce the spread of sexually transmitted infections," said Cynthia Graham, a research tutor on the Oxford Doctoral Course in Clinical Psychology and an associate research fellow at the Kinsey Institute. "This study has highlighted a difficulty -- loss of erection while using condoms -- that may make men more reluctant to use condoms. The findings have important implications for education and counseling efforts."
The study, which will appear in the upcoming November issue of Sexual Health, is part of an ongoing line of research at the Kinsey Institute into condom errors and problems, and is the first to evaluate erection problems associated with condom use.
Men were almost three times more likely to report erection loss if they were less confident about how to use condoms correctly, signaling the need for education on condom application. Men reporting problems with the "fit or feel" of condoms were about 2.2 times more likely to report erection loss compared with men not having these problems. The study authors suggest counseling and educational programs could make available a broader selection of condoms in terms of size and shape, as well as a selection of water-based lubricants.
Men who reported having sex with three or more partners in the past three months were almost twice as likely to report erection loss compared with men having fewer partners. These findings underline the importance of encouraging men to discuss condom use with new lovers.
The study involved 278 men ages 18 to 35 who visited an urban STD clinic in the Midwest between October 2004 and September 2005. The men all reported using a condom at least three times in the previous three months during intercourse with a woman. The men were asked about whether they had lost an erection during the sexual encounters and, if so, when it occurred (when the condom was put on or after sex had begun). The questionnaire also obtained information about whether condoms were removed during sex or not used at all and asked about possible problems, such as slippage or breakage and the ease in using them correctly.
Other key findings include:
-- Nearly three in 10 men (28.1 percent) reported that they had lost their erection while putting on a condom. This occurred once during the last three times they used a condom.
-- 13.4 percent reported they lost their erection once while using a condom during intercourse; 9.4 percent reported that this happened twice, and 3.6 percent reported that it happened all three times.
-- 17.3 percent reported losing an erection both while applying the condom and during sex.
-- Condoms were removed prematurely on at least one of the past three occasions by 40.8 percent of the men reporting erection loss, compared with 21.3 percent of men not reporting this problem.
-- Erection loss was more likely among men who reported at least one condom breakage (47.1 percent) compared with men not reporting breakage (32.5 percent).
The study coauthors are Richard Crosby, co-director of the IU-based Rural Center for AIDS/STD Prevention and professor at the College of Public Health at the University of Kentucky; William L. Yarber, a fellow of the Kinsey Institute for Research in Sex, Gender and Reproduction, senior director of RCAP and professor in IU Bloomington's Department of Applied Health Science and Department of Gender Studies; Stephanie A. Sanders, associate director of the Kinsey Institute, research fellow of RCAP and professor in the Department of Gender Studies; Kimberly McBride, a graduate student and researcher at the Kinsey Institute and Department of Applied Health Science; Robin R. Milhausen, assistant professor at the Social Justice and Sexual Health Research Lab, Department of Sociology and Anthropology, University of Windsor, Canada; and Janet N. Arno, affiliate of RCAP, associate professor at the Department of Infectious Diseases, IU School of Medicine, and co-director of RCAP.
The research was supported in part by the RCAP, which is a joint project of IU, the University of Colorado and the University of Kentucky, and by IU Bloomington's School of Health, Physical Education and Recreation.
"Erection loss in association with condom use among young men attending a public STI clinic: potential correlates and implications for risk behaviour," Sexual Health, 2006; 3(4).
Erection Hardness Scale Proves Effective In Assessing Erection Quality
The Erection Hardness Scale (EHS), an easy-to-use, four-point scale for The Erection Hardness Scale (EHS), an easy-to-use, four-point scale for erectile dysfunction (ED), provides a reliable measure of erection hardness and an indicator of other health and wellbeing outcomes, according to new data reported at the European Association of Urology.
EHS rates the hardness of erection on a scale of one to four, with four being the maximal score. The language used is simple and direct, so that men with ED can use the scale to assess the severity of their condition and to monitor the impact of treatment. A score of 1 indicates that the penis is larger than normal, but not hard; 2 means the penis is hard, but not hard enough for penetration, 3 means the penis is hard enough for penetration but not completely hard, and 4 indicates that the penis is completely hard and fully rigid.
A new study, SCORE 4 (Scoring Correspondence in Outcomes Related Erectile Dysfunction Treatment on a 4-point Scale), compared ratings on the Erection Hardness Scale with other scales commonly used in clinical trials of ED, including the International Index of Erectile Function (IIEF). It included 209 men (mean age 52 years) diagnosed with ED who were randomised to sildenafil or placebo, followed by an open-label extension period with flexible-dose sildenafil (50mg or 100mg).
The results showed a nearly linear relationship between EHS ratings and results from other scoring systems. The relationship between the discrete points of the EHS and scores on components of other rating scales, including the IIEF, showed the close correspondence between erection hardness and erectile function, satisfaction with the quality of an erection, the overall sexual experience and emotional well-being in men with ED.
Commenting on the clinical implications of the findings, Professor Herman van Ahlen, Professor of Urology, Klinikum Osnabruck, Muenster University, Germany, said: "These data validate the importance of measuring erection hardness because of its link to other factors."
Professor van Ahlen said that the Erection Hardness Scale provided a simple, effective tool that could be used in clinical practice for assessing patients with ED. He added: "The EHS measures more than just erection hardness. It can also provide an assessment of the other factors associated with this debilitating condition. A patient's satisfaction with erection hardness has the scope to predict satisfaction with other quality of life measures."n (ED), provides a reliable measure of erection hardness and an indicator of other health and wellbeing outcomes, according to new data reported at the European Association of Urology.
EHS rates the hardness of erection on a scale of one to four, with four being the maximal score. The language used is simple and direct, so that men with ED can use the scale to assess the severity of their condition and to monitor the impact of treatment. A score of 1 indicates that the penis is larger than normal, but not hard; 2 means the penis is hard, but not hard enough for penetration, 3 means the penis is hard enough for penetration but not completely hard, and 4 indicates that the penis is completely hard and fully rigid.
A new study, SCORE 4 (Scoring Correspondence in Outcomes Related Erectile Dysfunction Treatment on a 4-point Scale), compared ratings on the Erection Hardness Scale with other scales commonly used in clinical trials of ED, including the International Index of Erectile Function (IIEF). It included 209 men (mean age 52 years) diagnosed with ED who were randomised to sildenafil or placebo, followed by an open-label extension period with flexible-dose sildenafil (50mg or 100mg).
The results showed a nearly linear relationship between EHS ratings and results from other scoring systems. The relationship between the discrete points of the EHS and scores on components of other rating scales, including the IIEF, showed the close correspondence between erection hardness and erectile function, satisfaction with the quality of an erection, the overall sexual experience and emotional well-being in men with ED.
Commenting on the clinical implications of the findings, Professor Herman van Ahlen, Professor of Urology, Klinikum Osnabruck, Muenster University, Germany, said: "These data validate the importance of measuring erection hardness because of its link to other factors."
Professor van Ahlen said that the Erection Hardness Scale provided a simple, effective tool that could be used in clinical practice for assessing patients with ED. He added: "The EHS measures more than just erection hardness. It can also provide an assessment of the other factors associated with this debilitating condition. A patient's satisfaction with erection hardness has the scope to predict satisfaction with other quality of life measures."
EHS rates the hardness of erection on a scale of one to four, with four being the maximal score. The language used is simple and direct, so that men with ED can use the scale to assess the severity of their condition and to monitor the impact of treatment. A score of 1 indicates that the penis is larger than normal, but not hard; 2 means the penis is hard, but not hard enough for penetration, 3 means the penis is hard enough for penetration but not completely hard, and 4 indicates that the penis is completely hard and fully rigid.
A new study, SCORE 4 (Scoring Correspondence in Outcomes Related Erectile Dysfunction Treatment on a 4-point Scale), compared ratings on the Erection Hardness Scale with other scales commonly used in clinical trials of ED, including the International Index of Erectile Function (IIEF). It included 209 men (mean age 52 years) diagnosed with ED who were randomised to sildenafil or placebo, followed by an open-label extension period with flexible-dose sildenafil (50mg or 100mg).
The results showed a nearly linear relationship between EHS ratings and results from other scoring systems. The relationship between the discrete points of the EHS and scores on components of other rating scales, including the IIEF, showed the close correspondence between erection hardness and erectile function, satisfaction with the quality of an erection, the overall sexual experience and emotional well-being in men with ED.
Commenting on the clinical implications of the findings, Professor Herman van Ahlen, Professor of Urology, Klinikum Osnabruck, Muenster University, Germany, said: "These data validate the importance of measuring erection hardness because of its link to other factors."
Professor van Ahlen said that the Erection Hardness Scale provided a simple, effective tool that could be used in clinical practice for assessing patients with ED. He added: "The EHS measures more than just erection hardness. It can also provide an assessment of the other factors associated with this debilitating condition. A patient's satisfaction with erection hardness has the scope to predict satisfaction with other quality of life measures."n (ED), provides a reliable measure of erection hardness and an indicator of other health and wellbeing outcomes, according to new data reported at the European Association of Urology.
EHS rates the hardness of erection on a scale of one to four, with four being the maximal score. The language used is simple and direct, so that men with ED can use the scale to assess the severity of their condition and to monitor the impact of treatment. A score of 1 indicates that the penis is larger than normal, but not hard; 2 means the penis is hard, but not hard enough for penetration, 3 means the penis is hard enough for penetration but not completely hard, and 4 indicates that the penis is completely hard and fully rigid.
A new study, SCORE 4 (Scoring Correspondence in Outcomes Related Erectile Dysfunction Treatment on a 4-point Scale), compared ratings on the Erection Hardness Scale with other scales commonly used in clinical trials of ED, including the International Index of Erectile Function (IIEF). It included 209 men (mean age 52 years) diagnosed with ED who were randomised to sildenafil or placebo, followed by an open-label extension period with flexible-dose sildenafil (50mg or 100mg).
The results showed a nearly linear relationship between EHS ratings and results from other scoring systems. The relationship between the discrete points of the EHS and scores on components of other rating scales, including the IIEF, showed the close correspondence between erection hardness and erectile function, satisfaction with the quality of an erection, the overall sexual experience and emotional well-being in men with ED.
Commenting on the clinical implications of the findings, Professor Herman van Ahlen, Professor of Urology, Klinikum Osnabruck, Muenster University, Germany, said: "These data validate the importance of measuring erection hardness because of its link to other factors."
Professor van Ahlen said that the Erection Hardness Scale provided a simple, effective tool that could be used in clinical practice for assessing patients with ED. He added: "The EHS measures more than just erection hardness. It can also provide an assessment of the other factors associated with this debilitating condition. A patient's satisfaction with erection hardness has the scope to predict satisfaction with other quality of life measures."
Combination of erection pill and testosterone gel may benefit men who fail treatment with pill alone
For men with erectile dysfunction and low testosterone who do not respond to Viagra* (sildenafil) alone, the supplemental use of AndroGel** (testosterone gel) improves erectile function and overall sexual satisfaction, according to a NewYork-Presbyterian Hospital/Columbia University Medical Center study.
Dr. Ridwan Shabsigh, associate professor of urology at Columbia University College of Physicians & Surgeons and director of the New York Center for Human Sexuality at NewYork-Presbyterian Hospital/Columbia was the lead investigator in the study, which is published in the August issue of the Journal of Urology.
"Our data support the potential benefits of a combination therapy with testosterone gel for men with erectile dysfunction and low testosterone who find sildenafil by itself ineffective," said Dr. Shabsigh. "When assessing erectile dysfunction, doctors and patients should consider using a simple blood test to determine if low testosterone is a contributing factor. If the root cause is low testosterone, sildenafil alone won't fix the problem."
It is estimated that four to five million American men have low testosterone. Furthermore, low testosterone, also called hypogonadism or "low T," affects about one in 10 men between the ages of 40 and 60. Low testosterone may lead to decreased libido, erectile dysfunction, osteoporosis, reduced lean body mass, depressed mood and fatigue.
Sildenafil enhances the effects of nitric oxide, a chemical in the body that allows increased blood flow to the penis during sexual stimulation. "Research suggests nitric oxide may be dependent on testosterone to function properly," said Dr. Shabsigh. "While further studies are needed, this concept may explain why testosterone replacement therapy could help hypogonadal men who do not respond to sildenafil."
In the trial, 75 hypogonadal men (18 to 80 years old) were randomized to testosterone gel plus sildenafil versus placebo plus sildenafil. Participants were in a stable heterosexual relationship. Ninety-one percent had experienced erectile dysfunction for at least one year prior to the study. All participants had testosterone levels in the low to low/normal range (<400ng/dL) and had failed to respond to 100mg doses of sildenafil, based on questions from the International Index of Erectile Function (IIEF) scale.
Analysis of 70 men at four weeks found the population randomized to receive a daily dosage of 5mg testosterone gel in addition to a 100mg sildenafil (n = 37) taken as needed, had a significantly improved response to treatment, when compared to those on 100mg sildenafil plus a placebo (n = 33). Results of the Erectile Function Domain, Orgasmic Function Domain, Overall Satisfaction and Total Score on the IIEF were used to compare the groups. For Erectile Function Domain, the men receiving testosterone gel reported an average increase double those receiving a placebo, with a 34 percent and 17 percent improvement from baseline, respectively. On average, participants in the testosterone gel group reported a 28 percent increase from baseline in Orgasmic Function Domain compared to a 4 percent improvement in the placebo group, after four weeks of treatment. Overall Satisfaction improved 32 percent in the testosterone gel group, compared to 10 percent in the placebo group. The results at eight and twelve weeks showed a trend in favor of testosterone gel compared to placebo, but no statistical significance.
Dr. Shabsigh is the author of "Back to Great Sex: Overcome E.D. and Reclaim Lost Intimacy," a book developed to help men with erectile dysfunction communicate effectively with their physicians.
* Manufactured by Pfizer Inc.
** Manufactured by Unimed Pharmaceuticals, Inc., a Solvay Pharmaceuticals, Inc. company