Curriculum vitae 4. Advances in CNS Pharmacology for Sexual Dysfunction Dr. Kuang-Kuo Chen 30

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1 2 3 Curriculum vitae 4 Advances in CNS Pharmacology for Sexual Dysfunction Dr. Kuang-Kuo Chen 30 Chronic Pelvic Pain Syndrome and Sexual Dysfunction Dr. Chia-Chu Liu. Radical Prostatectomy: Evidence-based Approaches for Sexual Rehabilitation Dr. Han-Sun Chiang 34 New Insights of Premature Ejaculation Dr. Chris G McMahon Optimization of Erectile Dysfunction Management Dr. Sae Chul Kim Outcome Measures for Assessing Female Sexual Functioning Dr. Bang-Ping Jiann.. The Impact of Testosterone Deficiency on Men s Health Dr. Allen D Seftel.. 47 Testosterone and Prostate Cancer: From Myth to Scientific Understanding Dr. Farid Saad 55 TAA Consensus on Testosterone Replacement Therapy Dr. Chii-Jye Wang

2 Pre-Congress Symposium Sections Speakers Symposium Section IHighlights of 12 th APSSM (Asia-Pacific Society for Sexual Medicine) Section IIRecent Advances in Sexual Medicine Highlights of 12 th APSSM 1. Advances in CNS Pharmacology for Sexual Dysfunction 2. Chronic Pelvic Pain Syndrome and Sexual Dysfunction 3. Radical ProstatectomyEvidence-based Approaches for Sexual Rehabilitation Recent Advances in Sexual Medicine 1.Dr. Chris G McMahon New Insights of Premature Ejaculation 2.Dr. Sae Chul Kim Optimization of Erectile Dysfunction Management 3. Outcome Measures for Assessing Female Sexual Functioning 4.Dr. Allen D Seftel The Impact of Testosterone Deficiency on Men s Health 5.Dr. Farid Saad Testosterone and Prostate CancerFrom Myth to Scientific Understanding 6. TAA Consensus on Testosterone Replacement Therapy

3 Time: Contents Speaker 13:30-13:50 Registration 13:50-14:00 Opening Remarks 14:00-14:20 14:20-14:40 14:40-15:00 15:00-15:10 Break Section Highlights of 12 th APSSM Advances in CNS Pharmacology for Sexual Dysfunction Chronic Pelvic Pain Syndrome and Sexual Dysfunction Radical Prostatectomy: Evidence-based Approaches for Sexual Rehabilitation Recent Advances in Sexual Medicine 3 Moderator Moderator 15:10-15:35 New Insights of Premature Ejaculation Dr. Chris G McMahon 15:35-16:00 16:00-16:25 16:25-16:40 Discussion 16:40-16:55 Break Section 16:55-17:20 17:20-17:45 17:45-18:10 18:10-18:25 Discussion Optimization of Erectile Dysfunction Management Outcome Measures for Assessing Female Sexual Functioning The Impact of Testosterone Deficiency on Men s Health Testosterone and Prostate Cancer: From Myth to Scientific Understanding TAA Consensus on Testosterone Replacement Therapy Dr. Sae Chul Kim Moderator Dr. Allen D Seftel Dr. Farid Saad 18:25-18:30 Closing Remarks 18:30-19:00 Welcome Party B1 19:00~ Congress Banquet 6

4 Kuang-Kuo Chen, M.D., Ph.D. CURRICULUM VITAE Sex: Male Date of Birth: July 19, 1951 Medical Education: 1) National Defense Medical Center, Taipei, Taiwan, Republic of China (August 1969 August 1975) 2) National Yang-Ming University, Institute of Clinical Medicine, Taipei, Taiwan, Republic of China (September 1989 June 1992) Degree : Internship : M.D., Ph.D. Rotating Internship at Taipei Veterans General Hospital, Taiwan, Republic of China (July 1, 1974 June 30, 1975) Postgraduate Training: July 1979 June 1981 Rotating Residency Department of Surgery Taipei Veterans General Hospital, Taiwan, R.O.C. July 1981 June 1983 Fixed Residency Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taiwan, R.O.C. July 1983 June 1984 Chief Residency Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taiwan, R.O.C. July 1986 June 1987 Fellowship Department of Urology, Medical School, University of Minnesota, Minneapolis, Minnesota, U.S.A. Hospital Appointment: July 1984 Aug Attending Surgeon, Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taiwan, R.O.C. Sept July 2009 Chief, Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taiwan, R.O.C. July 2009 present Chairman, Department of Surgery, Taipei Veterans General Hospital, Taiwan, R.O.C. 4

5 Faculty Appointment: Aug July 1989 Instructor, Department of Surgery, National Yang-Ming Medical college Aug July 1992 Associate Professor, Department of Surgery, National Yang-Ming Medical college Aug July 1996 Professor, Department of Surgery, National Yang-Ming University Aug present Professor and Chairman, Department of Urology, National Yang-Ming University Membership in Medical Society: Taiwan Urological Association (former President) Taiwanese Association of Andrology (former President) Surgical Association of Republic of China Chinese Medical Association Taiwan Cooperative Oncology Group (TCOG) Prostate Cancer Committee American Urological Association International Society for Sexual Medicine Asia-Pacific Society for Sexual Medicine Publication: 210 Urological articles Address: Department of Surgery, Taipei Veterans General Hospital No. 201, section 2, Shih-Pai Road, Taipei, Taiwan, 112 Republic of China Telephone No.: , Fax No.:

6 CURRICULUM VITAE Dr. Chia-Chu Liu Sex: Male Date of Birth: Feb. 4, 1975 Address: Department of Urology, Kaohsiung Medical University Hospital No.100, TzYou 1 st Road, Kaohsiung 807, Taiwan Tel: (O) ext 7929 or 6694 Fax: m @hotmail.com Education: Field From To Place The Graduate Institute of Medicine, Kaohsiung Medical University The Graduate Institute of Medicine, Kaohsiung Medical University College of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan Kaohsiung, Taiwan Kaohsiung, Taiwan Academic Degree PhD Master MD Current Position: 1. Director (2010-Present) Department of Urology, Pingtung Hospital, Pingtung, Taiwan 2. Attending Urologist (2004- Present) Department of Urology, Kaohisung Medical University Hospital, Kaohsiung, Taiwan 3. Secretary General (2008- Present) The Taiwanese Association of Andrology, Taiwan Recent Publications: 1. Chia-Chu Liu, Hsu-Cheng Juan, Yung-Chin Lee, Wen-Jeng Wu, Chii-Jye Wang, Hung-Lung Ke, Wei-Ming Li, Hsin-Chih Yeh, Ching-Chia Li, Yii-Her Chou, Chun-Hsiung Huang, Shu-Pin Huang. The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men. Aging Male (Accepted) 2. Chia-Chun Tsai, Chia-Chu Liu, Shu-Pin Huang, Wei-Ming Li, Wen-Jeng Wu, 6

7 Chun-Hsiung Huang, Yung-Chin Lee, Shu-Yen Huang, Shu-Ching Pan. The impact of irritative lower urinary tract symptoms on erectile dysfunction in aging Taiwanese males. Aging Male (Accepted) 3. Chia-Fang Wu 1, Chia-Chu Liu 1, Bai-Hsiun Chen, Shu-Pin Huang, Hei-Hwa Lee, Yii-Her Chou, Wen-Jeng Wu, Ming-Tsang Wu *. Urinary melamine and adult urolithiasis in Taiwan. Clin Chim Acta (in press) 4. Shu-Pin Huang, Chao-Yuan Huang, Chia-Chu Liu, Chia-Cheng Yu, Yeong-Shiau Pu, Shih-Chieh Chueh, Hong-Jeng Yu, Tony T. Wu, Ching-Chia Li, Chun-Hsiung Huang, Wen-Jeng Wu. Clinical outcome of Taiwanese men with clinically localized prostate cancer post-radical prostatectomy: a comparison with other ethnic groups. Aging Male (in press) 5. Yung-Chin Lee, Wen-Jeng Wu, Chia-Chu Liu, Chii-Jye Wang, Wei-Ming Li, Chun-Hsiung Huang, Hsin-Chih Yeh, Hung-Lung Ke, and Shu-Pin Huang*. The Associations Among enos G894T Gene Polymorphism, Erectile Dysfunction, and Benign Prostate Hyperplasia-Related Lower Urinary Tract Symptoms. J Sex Med (in press) 6. Chia-Chu Liu, Shu-Pin Huang, Wen-Jeng Wu, Yii-Her Chou, Suh-Hang Hank Juo, Li-Yu Tsai, Chun-Hsiung Huang, and Ming-Tsang Wu *. The impact of cigarette smoking, alcohol drinking and betel quid chewing on the risk of calcium urolithiasis. Ann Epidemiol 2009;19: Chia-Chu Liu, Wen-Jeng Wu, Yung-Chin Lee, Chii-Jye Wang, Hung-Lung Ke, Wei-Ming Li, Hsi-Lin Hsiao, Hsin-Chih Yeh, Ching-Chia Li, Yii-Her Chou, Chun-Hsiung Huang, and Shu-Pin Huang. The prevalence of and risk factors for androgen deficiency in aging Taiwanese men. J Sex Med. 2009; 6: Yung-Chin Lee, Hui-Hui Lin, Chii-Jye Wang, Chia-Chu Liu, Wen-Jeng Wu, Chun-Hsiung Huang, Lin-Li Chang. The associations among GNB3 C825T polymorphism, erectile dysfunction, and related risk factors. J Sex Med. 2008; 5(9): Chia-Chu Liu, Shu-Pin Huang, Wei-Ming Li, Chii-Jye Wang, Yii-Her Chou, Ching-Chia Li, Chun-Hsiung Huang, and Wen-Jeng Wu. Relationships between serum testosterone and measures of benign prostatic hyperplasia in aging males. Urology 2007; 70:

8 10. Yuan-Chin Lee, Chun-Hsiung Huang, Chii-Jye Wang, Chia-Chu,Liu, Wen-Jeng Wu, Lin-Li Chang, Hui-Hui Lin. The associations among enos G894T gene polymorphism, erectile dysfunction and related risk factors. BJU Int. 2007; 100(5): Chia-Chu Liu, Chun-Hsiung Huang, Wen-Jeng Wu, Shu-Pin Huang, Yii-Her Chou, Ching-Chia Li, Chee-Yin Chai, and Ming-Tsang Wu. Association of vitamin D receptor FokI polymorphism with clinical presentation of calcium urolithiasis. BJU Int 2007, 99: Chia-Chu Liu, Shu-Pin Huang, Wei-Ming Li, Chii-Jye Wang, Wen-Jeng Wu, Yii-Her Chou, Chun-Hsiung Huang. Are lower urinary tract symptoms associated with erectile dysfunction in aging male of Taiwan? Uro Int 2006,77(3):

9 Han-Sun Chiang MD, PhD CURRICULUM VITAE Han-Sun Chiang is Professor and Vice-President at the Fu Jen Catholic University, Taipei, Taiwan, R.O.C. Prof Chiang is also Professor at the Department of Urology, National Taiwan University, and Taipei Medical University. He graduated from the National Taiwan University in 1975, where he undertook his residency at the Department of Urology before receiving further training at the Urological Clinic Rechts der Isar, Munich, Germany. He was appointed as Professor and chairmen at the Department of Urology of Taipei Medical University Hospital from 1983 to He held the appointment of Dean, College of Medicine at the Fu-Jen Catholic University from 2002 to Prof Chiang was also the President of the Taiwan Andrological Association ( ), Taiwan Urological Association ( ), and now is the President of Asian Pacific Society for Sexual Medicine (APSSM) ( ). Professor Chiang is widely respected figure in the field of surgical andrology and is primarily interested in the study of the aging male in Taiwan and Asia-Pacific region. Prof Chiang s research focus also includes male infertility and sexual dysfunction, medical history, ethics and education. He has published more than 150 academic papers on clinical and basic medical research in peer-reviewed journals and is frequently invited to present special lectures internationally. 9

10 CURRICULUM VITAE Assoc. Professor Chris G McMahon MB,BS (Monash) FAChSHM BRIEF BIOGRAPHY Chris G McMahon is a Consultant Sexual Health Physician and Fellow of the Royal Australian College of Physician s Chapter of Sexual Medicine. He is an Associate Professor in the Faculty of Health Sciences, University of Sydney and the Director of the Australian Centre for Sexual Health in Sydney, Australia. Dr McMahon is a committee chairman for the WHO Second and Third International Consultation on Erectile and Sexual Dysfunction and a chairman of the International Society of Sexual Medicine (ISSM) medical and research standards committee. He is an Associate Editor of the Journal of Sexual Medicine, and a member of the editorial board of the International Journal of Sexual Health, Current Sexual Health Reports and an associate section editor of the British Journal of Urology. He is a referee for multiple international peer-reviewed medical journals including the Journal of Sexual Medicine, the Journal of Urology, Urology, European Journal of Urology, the British Journal of Urology, the International Journal of Impotence Research, the Medical Journal of Australia and Expert Opinion on Investigational Drugs. He is a member of several local, regional and international medical associations and a committee member of the International Society of Sexual Medicine (ISSM). He has been invited to lecture on sexual medicine worldwide and has published extensively on sexual health. He has published over 50 original research and invited review articles in peer reviewed international medical journals, and 12 book chapters. His recent research has focused on drug treatment for patients with refractory erectile dysfunction (ED) and drug treatment of premature ejaculation. NAME: Dr Christopher Gordon McMahon DATE OF BIRTH: July ADDRESS: Australian Centre for Sexual Health Suite 2-4, 1A Berry Rd St Leonards NSW 2065 TEL: IDD FAX: IDD cmcmahon@acsh.com.au 10

11 EDUCATION Pre-Medical Christian Brothers College St Kilda, Melbourne Australia Undergraduate MB., BS Monash University, Melbourne, Australia Residency Internship Alfred Hospital Melbourne Junior Surgical Resident Alfred Hospital Melbourne Surgical Registrar Mont Park Hospital Melbourne Fellowships 1996 Fellow of the Australian College of Sexual Health Medicine 2005 Foundation Fellow of the Royal Australian College of Physician s Chapter of Sexual Medicine MEDICAL REGISTRATION Victoria Australia 1980 current New South Wales Australia POSITIONS Associate Professor Director Founding and Past President Committee Chairman Faculty of Health Sciences, University of Sydney Australian Centre for Sexual Health (1991-current) Australian Society of Impotence Medicine (ASIM) World Health Organisation (WHO) 3rd International Consultation on Sexual Dysfunction (2009) World Health Organisation (WHO) 2nd International Consultation on Sexual Dysfunction (2004) International Society of Sexual Medicine (ISSM) Standards Committee (2005-current) 11

12 Committee Member World Health Organisation (WHO) 1st International Consultation on Erectile Dysfunction (1998) Chairman of Scientific Committee 19 th Congress of World Association of Sexual Health (WAS) Sydney 2007 Associate Editor Journal of Sexual Medicine Editorial Board Member Associate Section Editor Committee Member Scientific Publication Referee Consultant/Member Medical Referee Medical Advisor Journal of Sexual Medicine Journal of Men s Health Current Sexual Health Reports The Journal of Medical Case Reports British Journal of Urology International Society of Sexual Medicine (ISSM) Journal of Urology Urology European Journal of Urology British Journal of Urology Journal of Sexual Medicine International Journal of Impotence Research Asian Journal of Andrology Medical Journal of Australia Expert Opinion on Investigational Drugs Current Sexual Health Reports Journal of Men s Health Future Medicine The Journal of Medical Case Reports NSW Ministerial Committee of Enquiry into Impotence Treatment Services in NSW NSW Health Care Complaints Commission (HCCC) Competition and Consumer Commission (ACCC) Therapeutics Goods Administration Australia (TGA) Australian Government Solicitors Department NSW Department of Public Prosecutions (DPP) 12

13 RECENT PUBLICATIONS 1. Priapism associated with concurrent use of phosphodiesterase inhibitor drugs and intracavernous injection therapy. Int J Impot Res Oct;15(5): Efficacy and Safety of Daily Tadalafil in Men with Erectile Dysfunction Previously Unresponsive to On-demand Tadalafil. J Sex Med 2004; 1: Disorder of Orgasm and Ejaculation in Men. J Sex Med (1): Comparison of efficacy and safety of on-demand tadalafil and daily dosed tadalafil for the treatment of erectile dysfunction. J Sex Med 2005, 3: A 6-month Study of the Efficacy and Safety of Oral Tadalafil in the Treatment of Erectile Dysfunction: A Randomised, Double-Blind, Parallel-Group, Placebo-Controlled Study. Int J Clin Pract. Vol 59, Issue 2, Page , February Efficacy of sildenafil citrate in men with premature ejaculation. J Sex Med, (3): Premature Ejaculation: Past Present and Future Perspectives. J Sex Med (suppl.2) Efficacy, safety and tolerability of daily tadalafil in men with diabetes mellitus and erectile dysfunction previously unresponsive to on-demand tadalafil. Submitted to European Urology 9. AUA Guidelines for the Management of Premature Ejaculation. American Urological Association The Etiology and Management of Premature Ejaculation. Nature Clin Prac Urol (9): New Agents in the Treatment of Premature Ejaculation (PE). Neuropsych Dis Treatment 2006:2(4) Tolerance to the Therapeutic Effect of Tadalafil Does Not Occur During 6 13

14 Months of Treatment: A Randomized, Double-Blind, Placebo-Controlled Study in Men with Erectile Dysfunction J Sex Med May; 3(3): Efficacy of type-5 phosphodiesterase inhibitors in the drug treatment of premature ejaculation: a systematic review - BJU Int Aug; 98(2): Treatment of erectile dysfunction with chronic dosing of tadalafil. Eur Urol Aug;50(2): Vardenafil improved erectile function in a real-life broad population study of men with moderate to severe erectile dysfunction in Australia and New Zealand J Sex Med Sep;3(5): Treatment of erectile dysfunction with chronic dosing of tadalafil. Eur Urol Aug;50(2): Premature Ejaculation. Indian Journal of Urology, 2007;23(2): Correlates to the Clinical Diagnosis of Premature Ejaculation: Results From a Large Observational Study of Men and Their Partners. J.Urol. 2006;177(3): Ejaculatory Latency vs. Patient-Reported Outcomes (PROs) as Study End Points in Premature Ejaculation Clinical Trials. Eur Urol Aug;52(2): Sexual Dysfunction in Men Receiving Methadone and Buprenorphine Maintenance Treatment. J Sex Med Mar;5(3): Epub 2007 Dec Hypogonadism in Men Receiving Methadone and Buprenorphine Maintenance Treatment. Int J Androl Oct 30. [Epub ahead of print] 22. An Evidence-Based Definition of Lifelong Premature Ejaculation: Report of the International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation. J Sex Med May 6. [Epub ahead of print] 14

15 BOOK CHAPTERS 1. Local Pharmacological Treatment Modalities. In Erectile Dysfunction. Ed. Jardin A, Wagner G, Khoury S, Giuliano F, Padma Nathan H, Rosen R. Health Publications Ltd Androgens in Male Physiology. In Male and Female Sexual Dysfunction. Ed. Seftel A, Padma Nathan H, McMahon CG, Giuliano F, Althof SE. Mosby Physiology of the Ejaculatory Response. In Male and Female Sexual Dysfunction. Ed. Seftel A, Padma Nathan H, McMahon CG, Giuliano F, Althof SE. Mosby Treatment of Ejaculatory Dysfunction. In Male and Female Sexual Dysfunction. Ed. Seftel A, Padma Nathan H, McMahon CG, Giuliano F, Althof SE. Mosby Disorders of Orgasm and Ejaculation in Men. In Sexual Medicine: Sexual Dysfunctions in Men and Women. Ed. Lue T, Wagner G, Khoury S, Giuliano F, Padma Nathan H, Rosen R. Health Publications Ltd Pharmacological Strategies in the Management of Premature Ejaculation. In Current Clinical Urology: Oral Drug Therapy of Sexual Dysfunction: A Guide to Clinical Management. Ed. Broderick GA. The Humana Press Evaluation and Therapy for Ejaculatory Disorders. In Atlas of Male Sexual Dysfunction. Ed. Lue TF. Current Medicine Clinical Manual of Sexual Medicine: Sexual Dysfunction in Men. Ed. Lue T, Khoury S, Giuliano F, Rosen R. Health Publications Ltd Ejaculatory Dysfunction. In. Male Sexual Function. A Guide to Clinical Management. Ed. J.J. Mulcahy; Pub. Humana Press Inc., Totowa, New Jersey, 2005 in press 10. Ejaculatory Dysfunction. In. Sexual Medicine. Standards in Clinical Practice. Ed. H. Porst, J Buvat. Blackwell, Premature Ejaculation. In. Handbook of Psychiatry. Ed. Rowland D, Incrocci, L. In Press

16 12. Medical Treatment of Ejaculatory Dysfunction. In. Textbook of Erectile Dysfunction. Ed Carson C, Goldstein I, Kirby R. In Press Erectile Dysfunction-Fast Facts Health Press UK

17 CURRICULUM VITAE Dr. Sae Chul Kim I. Professional Background : 1971; Graduated from Kyungpook National University, School of Medicine, Daegu, Korea ; Urology training in Kyungpook National University Hospital, Daegu, Korea 1980; Ph.D. Kyungpook National University, Daegu, Korea 1982; Research fellow, Brookdale Medical Center, N.Y., USA ; Assistant professor, Associate Professor, Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea ; Chairman, Department of Urology, Chung-Ang University College of Medicine ; Superintendent General, Chung-Ang University Yongsan Hospital ; President, Korean Andrological Society ; President, Korean Society of Fertility and Sterility ; President, Korean Society for Smooth Muscle Research ; Secretary General, Asia-Pacific Society of Impotence Research 1996; Secretary General, 3rd Asian Congress of Urology ; Program Organizing Committee member, International Society of Andrology Professor, Department of Urology, Chung-Ang University College of Medicine President, Korean Society for the Study of Female Sexual Health President elect, Korean Urological Association President elect, Korean Society of Sexology President, Asian-Pacific Society of Sexual and Impotence Research Local Organizing Committee Chairman, 2005 Congress of International Society of Andrology Organizing Committee member, Korea-Japan Urological Congress Executive Committee member, Asian Society of Andrology Council member, Asian Urological Association Associate Editor, Journal of Korean Medical Science Consultant, Journal of Urology Scientific Advisory Board, Andrologia Editor, Asian Journal of Andrology 17

18 II. Awards; 1) Academic Award from Korean Urological Association (1975, 1991, 1993, 1999, 2001, 2002) 2) Academic Award from Seoul Society of Korean Medical Association (1986) 3) Academic Award from the Asia-Pacific Society of Impotence Research (1989) III. Academic Achievements: 255 scientific papers have been published in the domestic or international journals Recent scientific papers published in the SCI idexed-international journals 1. Kim SC, Seo KK, Myung SC, Lee MY. Relaxation of rabbit cavernous smooth muscle to 17-estradiol: a non-genomic, NO-independent mechanism. Asian J Androl 2004;6(2): Choi HK, Ahn TY, Kim JJ, Kim SC, Paick JS, Suh JK, et al. A double-blind, randomized-placebo controlled, parallel group, multicenter, flexible-dose escalation study to assess the efficacy and safety of sildenafil administered as required to male outpatients with erectile dysfunction. Int J Impotence Res 2003;15(2): Kim SC, Chang IH, Jeon HJ. Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year. BJU International 2003;92(3): Kim HW, Kim SC, Seo KK, Lee MY. Effects of estrogen on the relaxation response of rabbit clitoral cavernous smooth muscles. Urol Res 2002;30: Seo KK, Kim SC, Lee MY. Comparison of peripheral inhibitory effects of clomipramine with selective serotonin re-uptake inhibitors on contraction of vas deferens: in vitro and in vivo studies. J Urol 165: , Seo KK, Kim SC, Jun IO, Oh MM, Lee MY. Synergistic effects of sildenafil on relaxation of rabbit and rat cavernosal smooth muscles when combined with various vasoactive agents. BJU International 87: , Heaton JPW, Lording D, Liu S-N, Litonjua A D, Guangwei L, Kim SC, Kim JJ, Zhi-zhou S, Israr D, Niazi D, Rajatanavin R, Suyono S, Benard F, Casey R, Brock G, Belanger A. Intracavernosal alprostadil is effectve for the treatment 18

19 of erectile dysfunction in diabetic men. Int J Impt Res 2001;13(6): Kim SC, Seo KK, Han JH, Lee MY. Inhibitory effect of serotonergic drugs on contractile response of rat vas deferens to electrical nerve stimulation: In vivo study. J Urol 163: , Kim SC, Seo KK, Kim HW, Lee MY. The effects of isolated lipoproteins and triglyceride, combined oxidized low density lipoprotein (LDL) plus triglyceride, and combined oxidized LDL plus high density lipoprotein on the contractile and relaxation response of rabbit cavernous smooth muscle. Int J Androl 23(suppl 2): 26-29, Kim SC, Seo KK, Park BD, Lee SW. Risk factors for an early increase in dose of vasoactive agents for intracavernous pharmacotherapy. Urol Int 65: , Kim SC, Ahn TY, Choi HK, et al. Multicenter study of the treatment of erectile dysfunction with transurethral alprostadil (MUSE) in Korea. Int J Impotence Res 12: , Kim SC. Hyperlipidemia and erectile dysfunction. Asian J Androl 2: , Kim SC, Seo KK, Kim IK, et al. Effects of bacterial endotoxin of the contraction and relaxation responses of the rabbit cavernous smooth muscles. J Urol 161: , Seo KK, Yun HY, Kim H, Kim SC. Involvement of endothelial nitric oxide synthase in the impaired endothelium-dependent relaxation of cavernous smooth muscle in hypercholesterolemic rabbit. J Androl 20: , Kim, SC, Seo KK, Yoon SH. Fracture at the input tube-cylinder junction of AMS 700 inflatable penile prosthesis as a complication of a modified implantation technique in a series of 99 patients. Urology 54: , Kim, SC. Mechanical reliability of AMS hydraulic penile prosthesis; from Asian point of view. Asian J Surg 22: , Kim, SC. Recent advancement in diagnosis of vasculogenic impotence. Asian J Androl 1: 37-43,

20 18. Kim SC, Lee MY, Seo KK. Comparison of relaxation responses of cavernous and trigonal smooth muscles from rabbits by 1-adrenoceptor antagonists; prazosin, terazosin, doxazosin, and tamsulosin. J Kor Med Sci 14: 69-74, Kim SC, Seo KK. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. J Urol 159: , Kim SC, Bang JH, Hyun JS, Seo KK. Changes in erectile response to repeated audiovisual sexual stimulation. Eur Urol 33: , Kim SC, Kim HW. Effects of nitrogenous components of urine on sperm motility - an in vitro study. Int J Androl 21: 29-33,

21 CURRICULUM VITAE Bang-Ping Jiann MD Kaohsuing Veterans General Hospital and Shu-Te University, Taiwan Ban-Ping Jiann is Associate Professor in the Human Sexology Research Centre and Graduate Department at Shu-Te University in Kaohsuing, Taiwan. He is also Visiting Staff in urology for the Department of Surgery in Kaohsiung Veterans General Hospital. A/Prof Jiann graduated from Taipei Medical College in Taipei, Taiwan, and completed his residency at Taipei Veterans General Hospital. He was Chief Resident at Taipei Veterans General Hospital before becoming a Research Fellow at Case Western Reserve University Hospital in Ohio, US, between July 1992 and June A/Prof Jiann is a member of various professional societies including the Taiwan Urological Society, European Society for Sexual Medicine and the International Society for Sexual and Impotence Research. He is also Chairman of the Local Organizing Committee for the 13th Asia-Pacific Society for Sexual Medicine to be held in A/Prof Jiann has published in various international peer-reviewed journals, and is on the editorial review board for the International Journal of Impotence Research, Journal of Sexual Medicine and European Urology. 21

22 CURRICULUM VITAE Allen D Seftel, M.D. Departmental Title: Head, Division of Urology Director, Urology Residency Training Program Specialty: Urology Board Certification: Board Certified in Urology National Board of Medical Examiners Medical Group: Cooper University Physician Medical School: SUNY Health Science Center at Brooklyn Internship: North Shore University Hospital Residency: SUNY Downstate Medical Center Case Western Reserve University School of Medicine Fellowship: Boston University Medical Center Awards and Honors: America s Top Doctors-2001-present Editorial Positions: Editor-in-Chief: International Journal of Impotence Research, The Journal of Sexual Medicine, Editor, Journal of Urology-Urologic Survey, Male and Female Sexual Function, Editorial Board, Journal of Andrology, Current Surgery, Post -Graduate Medicine, Net Wellness, Editor: Male Sexual Dysfunction, Post 22

23 Graduate Medicine, Editorial Board Member, Current Surgery, Editorial Board Member. Bibilography: Dr. Seftel is well published in his field. Memberships: American Medical Association, American Urological Association, American Fertility Society, American Andrology Society, American Association of Clinical Urologists, American Geriatric Society, American Diabetes Association, American Paraplegia Society, Society for Basic Urologic Research, Society of University Urologists, International Society of Sexual Medicine, Society for Study of Sexual Medicine, Society for Study of Male Reproduction, The Society of Laparoendoscopic Surgeons, The American Physiological Society, Society for Prosthetic Urology, International Society for Sexual Medicine. NPI [National Provider Identification]: Special Interests: Specialty: Male Sexual Medicine Male Sexual Function Male Infertility Benign Prostatic Hyperplasia Testosterone Deficiency in Men Office Locations: Three Cooper Plaza Suite 403 Camden, NJ Phone: (856) (856) Fax: (856) Church Road Suite 400 Marlton, NJ Phone: (856) (856) Fax: (856)

24 CURRICULUM VITAE Prof. h.c.* Dr. med. vet. Farid Saad Prinzenallee 28, Berlin, Germany Dec. 23 rd, 1953 born in Alexandria, Egypt semesters studies of human medicine at the University of Hamburg studies of veterinary medicine and preclinical exams at the Free University of Berlin studies of veterinary medicine, state exams, graduation and PhD at the Veterinary University of Hannover - during this time several working periods with equine practitioners in the U.S.A veterinary surgeon, employed by Dr. G. Kubitza in Hamburg, specialisation in race horses and equine reproduction sales representative and member of the sales force of Hoechst AG product manager, then marketing director and international marketing and sales director, Ferring GmbH in Kiel; specialist for reproductive endocrinology, pediatric endocrinology, and Andrology team leader reproductive medicine, Organon GmbH, Oberschleissheim leader of clinical development andrology, Jenapharm, Jena; specialist in endocrinology of aging, male aging, male hormonal fertility control. since May 2001 corporate strategic marketing Schering AG, Berlin; leader of product group Male Health Care Honorary professorship in clinical research and endocrinology at Gulf Medical College, Ajman, United Arab Emirates Honorary professorship at Men s Health Reproduction Study Center, Hang Tuah University, Surabaya, Indonesia Citizenship: German *Gulf Medical University School of Medicine, Ajman, UAE 24

25 Recent Publications 1. Farid Saad, Kamischke A, Yassin A, Zitzmann M, Schubert M, Jockenhövel F, Behre HM, Gooren L, Nieschlag E. More than eight years hands-on experience with the novel long-acting parenteral testosterone undecanoate. Asian J Androl 9(3): (2007) 2. Farid Saad, Anca S. Grahl, Antonio Aversa, Aksam A. Yassin, Ates Kadioglu, Ignacio Moncada and Ian Eardley. Effects of testosterone on erectile function: implications for the therapy of erectile dysfunction. BJU Int 99(5): (2007) 3. Heufelder A, Saad F, Gooren L. Additional therapeutic action of testosterone to the favourable effects of exercise and diet in diabetes type 2. J Urol 177(4): 228 (2007) 4. Yassin AA and Saad F. Erectile dysfunction, metabolic syndrome, hypogonadism are intertwined. J Urol 177(4): 288 (2007) 5. LJ Gooren, HM Behre, F Saad, A Frank, S Schwerdt. Diagnosing and treating testosterone deficiency in different parts of the world. Results from global market research. Aging Male 10(4): (2007) 6. F Saad, LJ Gooren, A Haider, A Yassin. An exploratory study of the effects of 12 months administration of the novel long-acting testosterone undecanoate on measures of sexual function and the metabolic syndrome. Arch Androl 53(6): (2007) 7. LJ Gooren, F Saad, A Haider, A Yassin, S Sakhri. A decline of plasma 5-dihydrotestosterone (DHT) levels upon testosterone administration to elderly men with subnormal plasma testosterone and high DHT levels. Andrologia (2008) 8. F Saad, LJ Gooren, A Haider, A Yassin. A dose response study of testosterone on sexual dysfunction and on features of the metabolic syndrome using testosterone gel and parenteral testosterone undecanoate. J Androl 29(1): (2008) 9. F Saad, LJ Gooren, A Haider, A Yassin. Effects of testosterone gel followed by parenteral testosterone undecanoate on sexual dysfunction and on 25

26 features of the metabolic syndrome. Andrologia 40(1): (2008) 10. A Yassin and F Saad. Plasma levels of dihydrotestosterone remain in the normal range in men treated with long-acting parenteral testosterone undecanoate. Andrologia 39(4): (2007) 11. A Haider, A Yassin, F Saad, R Shabsigh. Effects of androgen deprivation on glycemic control and on cardiovascular biochemical risk factors in men with advanced prostate cancer with diabetes. Aging Male 10(4): (2007) 12. F Saad, L Gooren, A Haider, A Yassin. Significance of plasma levels for effects of testosterone on the metabolic syndrome. Aging Male 11(1): 39 (2008) 13. F Saad, A Heufelder, L Gooren. Testosterone administration in addition to exercise and diet enhance therapeutic effects in men with type 2 diabetes with subnormal testosterone. Aging Male 11(1): 11 (2008) 14. YA Tishova, GZ Mskhalaya, F Saad, SY Kalinchenko. Effect of testosterone treatment on cardiovascular risk factors and variables of the metabolic syndrome (MS) in hypogonadal men. Aging Male 11(1): (2008) 15. A Yassin, A Haider, A Shamsodini, F Saad. The testicular volume alters under testosterone therapy. Aging Male 11(1): 18 (2008) 16. A Shamsodini, F Saad, A Yassin, R Alzubaidi, A Al Ansari. RigiScan monitoring of nocturnal tumescence in patients with low testosterone level treated with testosterone undecanoate. Aging Male 11(1): (2008) 17. A Yassin and F Saad. The link between erectile dysfunction, metabolic syndrome and testosterone deficiency: outcome of data analysis of 771 ED patients. Aging Male 11(1): 29 (2008) 18. SY Kalinchenko, EL Vishnevskiy, AN Koval, GJ Mskhalaya, F Saad. Beneficial effects of testosterone administration on symptoms of the lower urinary tract in men with late onset hypogonadism: a pilot study. Aging Male accepted (2008) 19. AM Traish, A Guay, R Feeley, F Saad. The dark side of testosterone 26

27 deficiency: I. Metabolic syndrome and erectile dysfunction. J Androl submitted (2008) 20. A Yassin and F Saad. The link between erectile dysfunction, metabolic syndrome and testosterone deficiency: outcome of data analysis of 771 ED patients. European Urology Supplements 7(3): 296 (2008) 21. F Saad, A Heufelder, L Gooren. Normalization of testosterone levels enhances the favourable effects of exercise and diet in men with diabetes type 2 with subnormal testosterone. J Androl (Suppl.): 54 (2008) 23. F Saad, A Haider, A Yassin, L Gooren. With regard to testosterone (patho)physiology men are not created equal. J Androl (Suppl.): 54 (2008) 24. M Zitzmann, E Vorona, M Wenk, F Saad, E Nieschlag. Testosterone administration decreases carotid intima media thickness as indicator of vascular damage in middle-aged overweight men. J Androl (Suppl.): (2008) 25. MC Meriggiola, F Armilotta, A Costantino, P Altieri, AM Perrone, F Saad, T Ghi, C Pelusi, G Pelusi. Effects of testosterone undecanoate (TU) administered alone or in combination with letrozole or dutasteride in female-to-male (FtM) transsexuals. J Sex Med (2008) 26. A Traish, A Guay, F Saad. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl (submitted) 27. A Yassin, A El-Sakka, F Saad. Testosterone and erectile dysfunction. In: Jones H, Testosterone Deficiency in Men, Oxford University Press, Oxford, UK 2008: F Saad. The role of testosterone in the metabolic syndrome. Journal of Steroid Biochemistry & Molecular Biology (accepted) 29. F Saad. C-reactive protein levels and aging male symptoms in hypogonadal men treated with testosterone supplementation. Journal of Steroid Biochemistry & Molecular Biology (accepted) 30. F Saad. Age and baseline testosterone value do not predict the beneficial effect of normalization of testosterone on the metabolic syndrome. 27

28 Journal of Steroid Biochemistry & Molecular Biology (accepted) 31. F Saad. Comparison of long-acting testosterone undecanoate formulation versus testosterone enanthate on sexual function and mood in hypogonadal men. Journal of Steroid Biochemistry & Molecular Biology (accepted) 32. A Haider, L Gooren, P Padungtod, F Saad. Safety aspects of administration of parenteral testosterone undecanoate to elderly men. Asian J Androl (submitted) 33. EJ Giltay, A Haider, F Saad, L Gooren. C-reactive protein levels and aging male symptoms (AMS) in hypogonadal men treated with testosterone supplementation. Andrologia (submitted) 28

29 (UCSF) UPPSALA 97 3 ~ 97 3 ~ 85 8 ~ 74 8 ~ ~ ~ ~ ~ ~9 (TUA) (TAA) (AUA) (APSSM) (ISSM) cjwang@kmu.edu.tw 29

30 Advances in CNS Pharmacology for Sexual Dysfunction Dr. Kuang-Kuo Chen Chairman, Department of Surgery, Taipei Veterans General Hospital, Taiwan, R.O.C. Currently, the neural mechanisms for penile erection through central nervous system (CNS) including many neural transmitters, modulators and pathway systems are still not clearly known. Some of the brain loci regarding to sexual function are reported to include the medial preoptic area (MPOA), paraventricular nucleus of hypothalamus (PVN), hippocampus, medial amygdala, periaqueductal gray (PAG), and ventral tegmentum. The MPOA integrates the sensory stimuli from higher brain areas. The PVN also integrates the sensory inputs from the higher brain centers and MPOA, and projects to spinal autonomic preganglionic neurons. The neural impulses may also transmit from PVN to the PAG, nucleus paragigantocelluaris (npgi) and raphe nuclei. The neurons in npgi send inputs to the spinal cord to inhibit penile erection. Stimulatory pathways for penile erection may transmit to spinal cord through PAG or disinhibition of npgi neurons. Pharmacological stimulation of MPOA and PVN with dopaminergic receptor agonist (apomorphine) may elicit penile erection and ejaculation in the rat. Apomorphine induces penile erection by releasing oxytocin in the CNS through activation of D1/D2 receptors and oxytocinergic neurons in the PVN. The agents of this pharmacologically mediated penile erection through the CNS at present include dopaminergic receptor agonist (apomorphine), melanocortin receptor agonist (melanotan II, PT-141), serotoninergic agonist acting at 5-hydroxytryptamine (5-HT) 2C receptors (m-chlorophenylpeperazine, p-chloroamphetamine), serotonin reuptake inhibitor (trazodone), selective α2-adrenoceptor antagonist (delequamine, yohimbine), opioid receptor antagonist (naltrexone), oxytocinergic receptor agonist, hexarelin receptor analogue (EP 50885, EP 60761), nitric oxide system (L-arginine) and excitatory amino acid (L-glutamate, N-methyl-D-aspatate). Among the present pharmacotherapeutic agents for male erectile dysfunction (ED), some induce penile erection through CNS which include trazodone, apomorphine, melanotan II, PT-141, yohimbine, naltrexone, delequamine and L-arginine. The current therapy for ED may be improved by understanding the CNS 30

31 pharmacology. New agent may be developed targeting the melanocortin receptors (MC 3-5 ) agonist, to provide a better therapeutic efficacy. Oxytocinergic and nitrergic receptors or pathways being always involved in the mechanism of most of current central acting drugs for ED are another interesting targets to design new agents. Selective dopamine receptor activation to enhance the efficacy and prevent side effect may be also a direction to search for new drugs acting through CNS for the management of male ED. 31

32 Chronic Pelvic Pain Syndrome and Sexual Dysfunction Dr. Chia-Chu Liu Department of Urology, Kaohisung Medical University Hospital, Kaohsiung, Taiwan Prostatitis is defined as painful inflammation of the prostate that is often associated with lower urinary tract symptoms (LUTS), as well as with sexual dysfunction or discomfort. It is the most common urologic diagnosis in men younger than 50 years and the third most common urologic diagnosis in men older than 50 years next to benign prostatitic hyperplasia and prostate cancer. Population-based estimates of the prevalence of prostatitis in the general male population range from 2 to 10%. According to National Institutes of Health (NIH) classification system for prostatitis, it was classified into four categories, including acute bacterial prostatitis (category), chronic bacterial prostatitis (category ), chronic pelvic pain syndrome (CPPS)(category ), and asymptomatic inflammatory prostatitis (category ). CPPS is both the most common form and the most challenging to evaluate and treat. The etiology of CPPS remains unclear. It is thought to cause by an interrelated cascade of inflammatory, immunologic, neuroendocrine, and neuropathic mechanisms that begin with an initiator (such as infection, immunogen, toxin, trauma, stress) in a genetically or anatomically susceptible men. The predominant symptoms of CPPS include chronic pain located in the part between the scrotum and testicules (i.e.,perineum), and below the waist areas, as well as pain at ejaculation and urination. As with other chronic pain conditions, many patients with CPPS report reduced quality of life and increased depression. CPPS is also known for its negative impact on sexual function. Men with CPPS tend to report ejaculatory pain, premature ejaculation, erectile dysfunction, decreased sexual desire, and decreased frequency of sexual activities than those without pelvic pain. Intimacy and couple relationships may also be affected by CPPS. Until now, the pathogenesis of CPPS-associated sexual dysfunction remains unclear. Physiologic factors and psychological factors may all play important roles in the link between these two entities. 32

33 Due to the complex relationship exists between CPPS and sexual function, a comprehensive approach to managing CPPS is needed. In addition to traditional pain management strategies, interventions to evaluate and improve sexual dysfunction should be integrated, which may help ameliorate CPPS symptoms and vice versa. Further CPPS treatment studies may suggested to include sexual function as a outcome measure to elucidate the their complex relationship. 33

34 Radical Prostatectomy Evidence based Approaches for Sexual Rehabilitation Han-Sun Chiang President, Asian Pacific Society of Sexual Medicine Recent literature evidence suggests early postoperative penile rehabilitation after radical prostatectomy can prevent cavernosal hypoxia fibrosis and penile atrophy. Serial reviews also show the penile rehabilitation can definitely decrease the incidence of permanent erectile dysfunction. According to the evidence appeared on the previous studies, we start our protocol of penile rehabilitation for patients after radical prostatectomy since this year. Based on our experience, we found the following thoughts might be more beneficial for the couples to have penile rehabilitation: 1.Preoperative counseling should be more comprehensive: including psychosocial concerns of their sexuality; questionnaire for the quality of life; the detail of sex therapy thereafter etc. 2.The regimen of penile rehabilitation should be more flexible. We provide different program of regular intracavernosal injection or/and oral intake of phosphodiesterase type 5 (PDE-5) inhibitors for the couples. The programs could also be switched during the treatment. It became more acceptable for the couples. 3.The penile rehabilitation should be taught and followed up by a special personnel. It would be even better performed by a clinical psychologist in combination with sex therapy. Our preliminary result showed that early penile rehabilitation with sex therapy can remain the couple s sexually active and easily achieve sexual satisfaction for them. It is a new goal of early penile rehabilitation for restoring a more complete sexual function. The concept of a new sex therapy may be promoted in other medical fields such as for any other major surgeries, for critical medical diseases and even for the aging couples whom lose of sexual function for a long period. Based on our preliminary result, almost all of the couples can accept the concept of penile rehabilitation to preserve the penile length and erectile function, even though they may not so active in sexual life. They can start the program as early as no more symptom of urinary incontinence. Compare with 34

35 the group of the patients without penile rehabilitation after radical prostatectomy the sexual function, sexual intimacy, quality of life is very much improved. We conclude that sexual rehabilitation should be a gold standard for the patients after radical prostatectomy. 35

36 New Insights of Premature Ejaculation Dr. Chris G McMahon Australian Centre for Sexual Health, Sydney Australia Ejaculatory/orgasmic disorders are common male sexual dysfunctions and include premature ejaculation, inhibited ejaculation, anejaculation, retrograde ejaculation and anorgasmia. Premature ejaculation (PE) is a common male sexual dysfunction with a prevalence that is relatively consistent across age groups and across countries. PE is associated with a substantial psychological and relationship burden for sufferers and their partners. Although recent epidemiological and observational research has provided new insights into premature ejaculation (PE) and the associated negative psychosocial effects of this dysfunction, the true prevalence of PE remains unclear. Community IELT stopwatch observational studies of unselected subjects demonstrate a positively skewed distribution of a broad range of lielts with a median IELT of 5.4 minutes % of men seeking treatment for lifelong PE ejaculate within 60 seconds. The first contemporary multivariate evidence-based definition of lifelong PE was developed in 2008 by a panel of international experts, and characterises lifelong PE as ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration, the inability to delay ejaculation on all or nearly all vaginal penetrations, and the presence of negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy. This definition is limited to heterosexual men engaging in vaginal intercourse. There is insufficient published evidence to propose an evidenced-based definition of acquired PE. Animal and human sexual psychopharmacological studies have demonstrated that serotonin and 5-HT receptors are involved in ejaculation and confirm a role for selective serotonin re-uptake inhibitors (SSRIs) in the treatment of PE. There is accumulating evidence to suggest that the intravaginal ejaculatory latency time (IELT) is a genetically influenced biological variable, suggesting that PE is a neurobiological disorder and that some men may be genetically prone to ejaculate with a brief latency. The evidence to support this includes animal studies showing a subgroup of persistent rapidly ejaculating Wistar rats, an increased familial occurrence of lifelong PE and the recently genetic 36

37 polymorphism of the 5-HT transporter protein gene which appears to determine the regulation of the IELT. Acquired PE is associated with sexual performance anxiety, ED, genitourinary infection, thyroid dysfunction or may be idiopathic. The off-label use of some SSRIs and clomipramine, along with the development and recent regulatory approval of dapoxetine for the treatment of PE, has drawn new attention to this common and often ignored sexual problem. However, until the neurobiological, physiological and psychological mechanisms responsible for PE are better understood, ideal treatment outcomes may remain elusive. 37

38 Optimization of Erectile Dysfunction Management Dr. Sae Chul Kim Department of Urology Chung-Ang University Hospital, Seoul, Korea For the optimal ED management, the first to consider is that healthcare professional has to redirect men into healthcare system. Healthcare professional should educate men to have a correct understanding about ED; ED is a medical issue, possibly associated with serious cardiovascular diseases and should be treated with genuine medicine. For the successful ED treatment, 1) the effective assessment of ED (predisposing, precipitating, and maintaining factors) by bio-psycho-social approach and impact on the couple, 2) accurate diagnosis, 3) identification of contributory factors to ED such as androgen deficiency and concomitant medications are mandatory. 4) Physicians have to know what is the goals for the man and his partner. The goal should be realistic and holistic. 5) physicians have to decide which treatments are most likely to allow them to achieve these goals. Optimal erection hardness is important to treat ED successfully because satisfaction with erection hardness is associated with greater levels of satisfaction with intercourse. According to European Sexual Confidence Survey conducted in 12 countries (2009), 95% of adults agree that it is important for a man to be sexually confident in order to have good sex, and 90% of men and women believe that a lack of sexual confidence, as a result of insufficiently hard erections, can have a negative impact on a man s life outside of sex. Men with ED treated with sildenafil regained confidence levels similar to men without ED. Secondarily, physicians should educate patient and partner how to optimise medication effect, and how to integrate medication use into their sexual activity, and should discuss partner sexual health and function and suggest pro-erectile lifestyle and behavioural changes. Prescribing issues include ensuring use of genuine medication, discussing risks to health of counterfeit medication, providing optimal dose and adequate supply, and promoting adequate usage. A study analysing 17 commercial formulations of herbal or dietary supplements marketed for sexual dysfunction said that 8 of the 17 contained compounds related to synthetic PDE5-inhibitors. Pharmacological risks posed 38

39 by counterfeit PDE5-inhibitors are incorrect or incomplete descriptions of product composition, presence of unknown pharmaceutically active ingredients, dosage variability, minimal or incorrect guidance about contraindications, unsupervised use by men with ED and serious co-morbid conditions, and addressing side effects caused by an unknown product is difficult and may be dangerous. Finally, adequate follow-up is stressed; 1) Enquire about and address sub-optimal response, 2) Address adverse effects, 3) Discuss partner sexual experience and treatment satisfaction, 4) Address any other treatment-emergent sexual and relationship problems. 39

40 Outcome Measures for Assessing Female Sexual Functioning Dr. Bang-Ping Jiann Kaohsiung Veterans General Hospital Female sexual dysfunction (FSD) contains four major categories of desire, arousal, orgasm, and pain problems. Defining and measuring FSD is a complex and challenging task. Several factors have confounded the theory and measurement of FSD including: the use of inappropriate male paradigm, difficulty in capturing the complexity of women s sexual response, and an evolving but untested classification of FSD. Measurement approaches for sexual dysfunction have proliferated in recent years, spurred in large part by the development of new treatments. In the past, physiological measures of penile tumescence in males and vaginal blood flow in females played an important role in clinical and research studies. More recently, a variety of brief, self-report measures have been developed for assessing male and female function across a variety of sexual domains. These brief, self-report measures have been shown to have a high degree of reliability and validity and to be sensitive to treatment interventions and are widely employed in clinical trials as well as for clinical screening and diagnostic purposes. Self-report measures of sexual function exist in several forms, including self-administered questionnaires, daily diary records, and event log measures of sexual behavior. The Female Sexual Function Index (FSFI) is a validated (19-item) questionnaire that has been widely used in epidemiological studies and clinical trials since the past decade. The FSFI assesses aspects of female sexual function in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain, and yields six domain scores and a total score. The six FSFI subscales and the FSFI total score discriminated very well between women with and without sexual problems. The measure was shown to have a high degree of internal consistency and test-retest reliability and differentiated well between the two groups. Highly significantly differences were observed in all six dimensions between the patients and controls, indicating that the measure is very sensitive in differentiating responses between sexually dysfunctional and nondysfunctional women. The Sexual Function Questionnaire (SFQ) is a 31-item, multidimensional questionnaire recently developed for use in clinical trials of sildenafil in women 40

41 with sexual arousal disorders. The questionnaire assesses sexual function in seven dimensions: desire, physical arousal, lubrication, enjoyment, orgasm, pain, and partner satisfaction. The questionnaire was validated in two, large-scale clinical trials including 781 women with sexual dysfunction. The SFQ has strong psychometric properties and initial validation data. The high level of treatment responsiveness suggests that the measure is well suited for use in clinical trials of androgen replacement therapy. Its psychometrics and multilingual forms make it an excellent questionnaire that would benefit from more use in clinical trials and comparison to the more widely used FSFI. To qualify for the diagnosis of sexual dysfunction, a woman should show evidence of significant personal distress in relation to her sexual problem. Personal distress can be assessed by means of interview or questionnaire. The Female Sexual Distress Scale (FSDS) is a 12-item scale that assesses subjective distress associated with sexual dysfunction in clinical trials and has been shown to have a high degree of test-retest reliability (0.91) and internal consistency (0.88). The measure also discriminates well between women with and without sexual dysfunction and has been shown to be sensitive to the effects of treatment. The measure is highly recommended for inclusion in clinical trails of FSD. In conclusion, a number of self-report measures have been developed for multidimensional assessment of female sexual functioning that have demonstrated adequate psychometric properties, including test-retest reliability, internal consistency, and discriminant validity. Personal distress is an important component of FSD and can be reliably assessed by the FSDS. 41

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47 The Impact of Testosterone Deficiency on Men s Health Dr. Allen D Seftel, MD Head, Division of Urology Cooper University Hospital Camden, NJ Professor of UrologyRobert Wood Johnson SOM 47

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55 Testosterone and Prostate Cancer: From Myth to Scientific Understanding F Saad 1,2, A Yassin 2,3, A Haider 4 1 Scientific Affairs Men s Healthcare, Bayer Schering Pharma, Berlin, Germany 2 Gulf Medical University School of Medicine, Ajman, UAE 3 Segeberger Kliniken, Norderstedt, Germany 4 Private Urology Practice, Bremerhaven, Germany Background: Throughout the world, there is an increased interest in using testosterone for the treatment of late-onset hypogonadism (LOH) or testosterone deficiency syndrome (TDS) in aging men. However, concerns of inducing prostate diseases both prostate cancer and BPH/LUTS oftentimes outweigh the benefits of testosterone therapy resulting in a high degree of hesitance whether to treat hypogonadism. Evidence from epidemiological studies: From a large number of epidemiological studies, there is no evidence that endogenous testosterone or any other androgens are associated with prostate diseases. Studies in hypogonadal men reveal that men with testosterone deficiency have smaller prostates and lower levels of prostate specific antigen (PSA) than eugonadal men. Evidence from testosterone treatment studies: When testosterone levels in hypogonadal men are normalised, their prostates normalise resulting in initial moderate increases in both volume and PSA. These increases occur within the first six months of treatment and are to be expected as the prostate is an androgen-dependent organ which needs testosterone for normal development and functioning. Following this initial increase, volume and PSA reach a plateau. Studies and meta-analyses of controlled trials show that the incidence of prostate cancer in testosterone-treated elderly men is the same as in placebo-treated men and comparable to large-scale prostate cancer screening studies. In experimental study designs, extreme doses of testosterone up to four- to five-fold higher than what is considered physiological did not have an effect on PSA or prostate volume. Patients at high risk: Rhoden and Morgentaler treated men with biopsy-confirmed 55

56 prostate intraepithelial neoplasia (PIN) with testosterone for one year with a PIN-free group serving as control. They came to the conclusion that men with PIN do not have a greater increase in PSA or a significantly increased risk of cancer than men without PIN. Between 2004 and 2009, three series were reported of men (n = 74) who received testosterone treatment after curative radical prostatectomy. None of the man had a biochemical recurrence of their prostate malignancy. Intra-prostatic hormone milieu: In several studies, intra-prostatic concentrations of testosterone and DHT were measured under testosterone therapy. While serum levels of both androgens increased upon testosterone administration, there were no changes in intra-prostatic hormone levels indicating that the prostate creates its own hormonal milieu. Morgentaler and Traish in their 2009 review have developed a saturation model of testosterone effects on the prostate based on the evidence among others that there is a limited number of androgen receptors which does not change with testosterone treatment. Therefore, there is only a maximum response possible which can not be further exceeded. Several studies indicate that low testosterone may be associated with higher-grade prostate cancer, positive surgical margin following radical prostatectomy, and lower survival. BPH/LUTS: In 1993, a first Swedish paper by Holmaeng mentioned an improvement in urinary flow parameters. It took 15 years until a series of papers confirmed these early observations and showed results of improved subjective (by IPSS) and objective parameters of urinary function. In summary, based on the current scientific and medical evidence, there is no evidence that testosterone treatment increases the risk of prostate diseases in hypogonadal men. Since there is no definitive proof, the answer is to follow the guidelines on testosterone treatment in elderly men issued by and endorsed by a substantial number of medical societies. Treating hypogonadism with physiologic testosterone doses after proper diagnosis and under proper monitoring according to the guidelines can be considered acceptably safe. 56

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