Int Urol Nephrol (2009) 41:303–312

DOI 10.1007/s11255-008-9417-9

UROLOGY – ORIGINAL PAPER

Prostatic profile, premature ejaculation, erectile function

and andropause in an at-risk Mexican population
J. Jaspersen-Gastelum Æ J. A. Rodrı́guez Æ
F. J. Espinosa de los Monteros Æ L. Beas-Sandoval Æ
José Guzmán-Esquivel Æ D. D. Calvo Æ
T. Gutiérrez

Received: 1 March 2008 / Accepted: 9 June 2008 / Published online: 15 July 2008
Ó Springer Science+Business Media, B.V. 2008

Abstract (n = 1,316). Prostatic symptomatology in accor-

Objective To determine the frequency of prostatic dance with the international prostate symptom score
symptomatology, premature ejaculation (PE), erectile was 7.96 points. A total of 41.9% of participants
function, symptoms in the older adult/andropause reported experiencing PE. The average time to reach
assessment and to determine the risk factors involved. ejaculation was 10.97 min. Of the participating
Materials and methods The study was conducted by individuals, 39.5% were diagnosed with andropause.
the Mexican Society of Urology and was carried out Prostatic symptomatology was associated with risk
from June to October 2006. Epidemiological informa- factors of age and prostatitis, P \ 0.01. Premature
tion was obtained through the completion of four ejaculation and erectile dysfunction were associated
validated questionnaires by patients receiving non- with age, P \ 0.01. Vasomotor problems in the older
institutional urology treatment. The large database was adult were identified with an association tendency
statistically analyzed using a logistic regression model. towards alcoholism and excess weight, P \ 0.063,
Results A total of 1,779 men with an average age of but without statistical significance. Sexual problems
56.6 years were included in the study. The average in the older adult were associated with diabetes
prostate-specific antigen value in the sample was 1.73 mellitus, P \ 0.01. Andropause was associated with
traumatic problems in general.
J. Jaspersen-Gastelum
Hospital Ángeles Metropolitano, Tlacotalpan 59-135 Col. Keywords Andropause
Erectile function

Roma Sur., Mexico, DF, Mexico Premature ejaculation
e-mail: jaspersen@prodigy.net.mx

J. A. Rodrı́guez
F. J. Espinosa de los Monteros

L. Beas-Sandoval
J. Guzmán-Esquivel
D. D. Calvo
‘‘For Healthy Fathers’’ Campaign of the Mexican Society
of Urology, Mexico, Mexico Introduction
J. Guzmán-Esquivel (&)
University of Colima, Zaragoza 377, Centro. CP 28000, Lower urinary tract obstructive symptoms are a very
Colima, Mexico common clinical condition in adult men and are
e-mail: enicetoeto@hotmail.com frequently associated with sexual disorders concern-
ing ejaculation and signs and symptoms of androgen
T. Gutiérrez
Sanofi-Aventis, Av. Universidad esq. Miguel Ángel de deficiency. These symptoms are considered to be
Quevedo, Coyoacan, DF, Mexico inevitable age-related conditions [1, 2].

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Some studies have demonstrated a very elevated testosterone deficiency. Other correlated studies have
prevalence, even higher than 50%, of prostatic associated body mass loss and memory disorders with
symptoms in men over 50 years of age [3]. testosterone decline in elderly men.
Benign prostatic hyperplasia (BPH) is a histolog- The distribution of the principal urology patholo-
ical diagnosis common in the medical environment. gies in adult men in Mexico is not known with
However, even though BPH is a very frequent precision. The studies that have been carried out to
condition, it is not necessarily related to obstruction define its distribution and frequency tend to be
caused by prostate enlargement and urodynamic regional and often focus on only part of the problem.
changes [4]. Likewise, the association of diverse urinary
Many questionnaires assessing prostatic and sex- pathologies to one another is not known with
ual symptoms have been validated, allowing an certainty, nor have risk factors been identified.
evaluation to be made of the signs and symptoms Therefore, the decision was made to carry out a
of the lower urinary tract and sexual disorders. They national epidemiological study on various urologic
provide scores or ranges for identifying disease and conditions such as prostatic symptomatology, PE,
its degree and they set down a treatment guide [5–7]. erectile function and symptomatology in the older
In particular, erectile dysfunction (ED) is a adult as an andropause indicator.
pathological condition frequently associated with The objective of the present study was to deter-
infravesical urinary obstruction and is defined as the mine the frequency, distribution and association of
incapacity to achieve and maintain penile erection of diseases in the older adult in an at-risk Mexican
sufficient quality and duration in order to have population.
satisfactory sexual relations [8].
Disease prevalence increases with age. Severe
(5%) and moderate (17%) ED have been reported in Materials and methods
men from 40 to 49 years of age. In men from 70 to
79 years of age, the percentages increase to 15% and An analytical cross-sectional study was carried out on
34%, respectively [9, 10]. a national level by urologists throughout country who
Erectile dysfunction must be differentiated from had been summoned by the Mexican Society of
other sexual disorders such as premature ejaculation Urology. The study was executed from June to
(PE) and disorders of the libido. Various question- October 2006 as part of the ‘‘For Healthy Fathers’’
naires have been validated to evaluate sexual function 2006 campaign. Epidemiological information was
and include the international index of erectile func- obtained from 4 validated questionnaires completed
tion and other simpler recent editions [11, 12]. by patients receiving regular urologic medical atten-
Erectile dysfunction is associated with a large tion and from their clinical histories. The applied
number of pathological conditions that directly questionnaires included the following:
influence its development, such as prostatic hyper-
1. Clinical History.
plasia, diseases of the central nervous system,
2. International Prostatic Symptomatology
smoking, diabetes mellitus, endocrine disorders, and
Questionnaire.
cardiovascular diseases, among others [13–17].
3. International Index of Erectile Function
On the other hand, androgen deficiency has been
Questionnaire.
demonstrated in many clinical studies which report a
4. Premature Ejaculation Questionnaire.
decline in serum testosterone levels in elderly men.
5. Symptoms in the Older Adult Questionnaire/
Disorders derived from this decline have been
Andropause Determination.
attributed to dysfunctions of the hypothalamic–
hypophysis axis, leading to secondary hypogonadism The questionnaires were applied by participating
[18–20]. Validated questionnaires are also able to physicians to healthy individuals receiving urologic
evaluate disorders due to this hormonal decline consultation and to patients who accepted being
[21, 22]. enrolled in the study. All participants signed a letter
Brown-Sequard was the first to suggest that some of informed consent. A large database was gathered
of the symptoms associated with age were due to and later revised and subjected to statistical analysis.

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Variables of interest 1. Ejaculation before or at the beginning of

penetration.
The following study variables were determined. 2. Ejaculation before it is desired.
3. Anxiety level about premature ejaculation.
Clinical history 4. Partner relationship difficulty due to premature
ejaculation.
Participants were questioned about their age, demo- 5. Average ejaculation time after penetration.
graphic characteristics, chronic-degenerative con-
comitant diseases (high blood pressure, diabetes
Erectile function
mellitus), personal history of pathologies and life-style
(alcoholism, smoking, obesity, drug or toxic substance
To evaluate erectile function, the International Index of
abuse, surgeries and traumatisms).
Erectile Function questionnaire assessing erection level
The types of surgery considered important for the
with the following six questions from the DAN-PSS-SEX
study were: bladder, ureteral, retroperitoneal, pros-
(Danish Prostatic Symptom Score) [12] was applied:
tate, urethra, and spinal column surgeries as well as
central or peripheral nervous system surgeries. Trau- 1. Erection capacity during sexual activity.
matisms were considered to be those whose lesions 2. Erection for achieving penetration.
affected the urinary system such as spinal column 3. Penetration frequency.
fractures with spinal medulla and nerve root lesions, 4. Frequency in maintaining erection.
pelvic fractures and internal organ lesions. 5. Difficulty in maintaining erection until finishing
coitus.
Prostatic symptomatology 6. Confidence level in being able to maintain
erection.
The International Prostatic Symptomatology Question-
naire was applied for this evaluation. It consists of seven
Symptoms in the older adult/andropause
questions pertaining to prostatic symptoms for assessing
symptomatology. A final question was elaborated to
The Symptoms in the Older Adult Evaluation or
determine quality of life as a result of the urinary
Andropause Determination was applied [22] and all
symptoms [7]. The questions cover the following points:
study participants, regardless of their ages, completed
1. Difficulty in controlling (holding back) urination. this questionnaire consisting of 20 questions. The
2. Straining in order to pass urine. questions were grouped into 4 key areas for the
3. Weakening of the urine stream. individual or urology patient:
4. Intermittent urination.
I. Physical problems.
5. Incomplete emptying of the bladder sensation.
II. Vasomotor problems.
6. Repetitive urination.
III. Psychological problems.
7. Nocturnal urination.
IV. Sexual problems.
8. How the person would feel if his present urinary
symptoms were to continue for the rest of his life. Andropause diagnosis was determined with this
questionnaire according to the score obtained and was
This last item gives more importance to the score of
considered to be present when there was a score of
the individual or patient than to the quality of life he
three or more in the physical or vasomotor problem
perceives due to the presence of his present prostatic
section, four or more in the psychological problem
symptoms.
section and eight or more in the sexual problem section.
Premature ejaculation
Data analysis
A questionnaire consisting of five questions evaluat-
ing PE and covering the following points was applied The database underwent a quality control process and only
[12]: qualifying data were included in the statistical analysis.

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When an excluding or aberrant value was identi- a higher percentage of married men (83.4%), fol-
fied, only the questionnaire in which it was found was lowed by single and divorced men who made up
eliminated. The other questionnaires completed by 10.9% of the total when combined.
the same participant were still included. This allowed Table 2 shows the response distribution for dif-
for a broad sample, strengthening the statistical ferent pathology histories of the study participants.
analysis. Of the participants, 14.4% reported being diagnosed
Open responses referring to medication, products, with diabetes and 64.9% of them said they were
diet and treatment received were excluded from the following a specific diet. The average period of time
statistical analysis. Open response dispersion makes with the disease was 9.83 years. High blood pressure
the analysis and definition of tendencies and statis- (HBP) was reported by 19.7% of participants and
tical differences difficult to carry out. 45.9% of them said they were also following a
Descriptive analysis was applied to the database of specific diet. The average period of time with
patients passing the quality control (QC) process in hypertension was 7.54 years.
order to express the characteristics and assessment of Only 4.1% of the participants reported cardiopa-
the urology profile of the study population and a thies and only 0.7% reported oncology histories. Only
logistic regression model was used to determine 10.6% of participants reported traumatism anteced-
association among variables and risk factors. ents, 57.8% of them being back or pelvis
Statistical significance was considered when traumatisms. A total of 14.4% of the sample reported
P \ 0.05. The sample was made up of 1,779 patients having had prostatitis.
receiving medical treatment from participating phy- In relation to tobacco and alcohol consumption,
sicians affiliated with the Mexican Society of 23% of the sample reported having the habit of
Urology. The study was carried out from June to smoking and 32.9% reported drinking alcohol on a
October 2006. regular basis. The sample average period of time
smoking was 23.06 years (range 0–60). The average
number of cigarettes smoked per day was 8.62 (range
Results 1–45). Study participants reported an average period

A total of 1779 individuals were included in the Table 2 Antecedent distribution

study. The questionnaires from each category were Antecedent Yes No Total N
completed by a different number of participants and
then evaluated. Total % Total %
The following general characteristics were found Previous surgery 439 52.0 405 48.0 844
in the study patients and are shown in Table 1. The Allergies 176 16.3 902 83.7 1,078
four variables (age, weight, height and body mass Diabetesa 187 14.4 1,109 85.6 1,296
index) were determined from only 549 patients. Diabetes with diet 63 64.9 34 35.1 97
Sample age distribution showed the most frequent HTNb 249 19.7 1,014 80.3 1,263
range to be that of 51–60 years, followed by that of HTN with diet 17 45.9 20 54.1 37
61–70 years. Sample civil status distribution showed Cardiopathies 51 4.1 1,195 95.9 1,246
Neoplasias 8 0.7 1,177 99.3 1,185
Table 1 General population characteristics a Traumatisms 130 10.6 1,092 89.4 1,222
Back/pelvis Tc 52 57.8 38 42.2 90
Characteristic Mean Range
Prostatitis 152 14.4 902 85.6 1,054
Age (years) 56.6 31–84 Circumcision 43 10.7 358 89.3 401
d
Weight (kg) 81.6 48–164 Prostatic check up 165 31.7 355 68.3 520
Height (m) 1.72 1.51–2.00 a
Average diabetes duration 9.83 years (n = 124)
BMIb 27.6 21.1–41.0 b
Average HTN duration 7.54 years (n = 108)
a c
n = 549 Back or pelvis traumatism
b
BMI Body Mass Index equal to weight/(height)2 d
Time elapsed since last check-up 3.77 years (n = 164)

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of time consuming alcohol of 21.50 years (range 1– Table 4 Prostatic symptomatology response distribution
50). An average of 4.2 glasses/occasion was reported Variable Meana SD N
(range 1–12). The average frequency of alcohol
ingestion was every 3.8 days (range 1–10). Difficulty in postponing urination 1.00 1.47 1,627
Other antecedents of interest reported by the study Straining to begin passing urine 0.66 1.26 1,638
participants showed that 49.5% had a family history Reduction in urine stream strength 1.35 1.68 1,631
of diabetes, 39.2% a family history of HTN and Intermittent urination 1.16 1.55 1,637
17.3% a family history of prostate or breast cancer. Feeling that the bladder has not fully 1.11 1.54 1,629
Only 16.9% of the participants explored had normal emptied
blood pressure while 60.1% were diagnosed with Repetitive urination in \2 h 1.26 1.55 1,617
high blood pressure and 23% with low blood a
Value scale in the last month:
pressure. 0 = Never
Physical exploration of the patients resulted in a 1 = Approx. 1 time in 5
wide margin of normal percentage values. Normality 2 = Approx. 1 time in 3
for cardiac frequency was 98.9% and testicular and 3 = Approx. 1 time 2
rectal exploration produced values of 90.9% and 4 = Approx. 2 times in 3
86.4%, respectively. 5 = Almost always
Prostatic exploration resulted in Grade I diagnosis
SD: Standard deviation
in 60% of the participants and Grade II in 27.1%.
The prostate-specific antigen (PSA) value was
highest in the younger age group, and in general PSA with values identifying them as PE positive, 41.9%
increased in direct proportion to age. Table 3 shows stated that they ejaculated prematurely, but only 3.8%
PSA values reported in those participants who had reported doing so before penetration of their sexual
blood tests to determine them. The group general partners.
average was 1.73 with ranges from 0 to 111. With respect to PE frequency, the sample
Prostatic symptomatology values are shown in responded with an arithmetic mean of 4.65, corre-
Table 4. A low tendency was seen in the answers to sponding to a frequency of ‘‘sometimes’’. Anxiety
the six questionnaire questions. Prostatic symptom- level caused by PE reached a mean of 1.78,
atology assessment distribution was slight in 63.6% corresponding to ‘‘no anxiety’’ or ‘‘a little anxiety’’.
of the cases, moderate in 27.5% of the cases and The study response to whether PE caused some type
severe in 8.9% of the study participants, correspond- of difficulty with the sexual partner was a mean of
ing to 157 individuals. 1.58, corresponding to ‘‘no difficulty’’ or ‘‘a little
Quality of life as a result of present symptomatol- difficulty’’.
ogy was assessed by the study participants at an Although the number of answers to the question
arithmetic mean of 2.09, corresponding to ‘‘generally ‘‘over the past month how much time elapsed before
satisfied’’. ejaculation while having sexual relations’’ dropped
Premature ejaculation was analyzed with the spe- importantly (n = 862), the response average was
cific questionnaire for that disorder. Of the individuals 10.97 minutes (SD 9.394 min, range 0–60).

Table 3 Prostate-specific
Individuals Age range Mean PSA Minimum Maximum
antigen (PSA) values
(years) range PSA range PSA
n %

272 20.7 41–50 0.90 – 4.010

512 38.9 51–60 1.27 – 21.00
314 23.8 61–70 2.75 – 111.00
141 10.7 [from 70 2.93 – 76.00
75 5.7 Losses – – –
1,314 100.0 Total 1.73 – 111.00

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The International Index of Erectile Function was Table 6 Erectile function and answer distributiona
applied to assess function in the study population and Answer Variables
the responses are shown in Table 5.
In relation to erection capacity, the study popula- Erection Erection Penetration Post-
capacity quality frequency penetration
tion reported a mean of 2.3, corresponding to ‘‘always erection
or almost always’’ having an erection during sexual frequency
activity. Erection quality for penetration showed a
I had no 16.1 15.1 15.1 14.2
mean of 2.51, corresponding to ‘‘always/almost sexual
always’’ and ‘‘many times’’ and penetration fre- activity
quency reached a mean of 2.39, corresponding to Always or 58.5 56.8 62.1 52.8
‘‘always/almost always’’ and ‘‘many times’’. almost
Post-penetration erection frequency reached a always
mean of 2.62, also corresponding to ‘‘always/‘‘almost Many times 7.4 7.7 5.7 8.9
always’’ and ‘‘many times’’. Nevertheless, when Sometimes 7.0 7.5 7.1 8.1
asked about erection quality up to the end of the A few times 6.8 7.7 6.1 9.4
sexual act, the mean response was 4.48 (SD 1.803, Never or 4.2 5.2 4.1 5.7
n = 1,184), corresponding to ‘‘difficult/a little almost
never
difficult’’.
Normal diagnosis was reported by physicians n = 1,192
a
participating in the study in 6.9% of the subjects, Quantities presented in percentages
corresponding to 37 individuals.
And finally, confidence in reaching and maintain- questionnaire consists of the evaluation of four key
ing erection was assessed by study participants with elements: physical problems, vasomotor problems,
an average response of 2.69 (SD 1.214, n = 1,166) psychological problems and sexual problems. Each
corresponding to ‘‘high/regular’’. element was qualified separately and andropause
Table 6 shows the percentages the answers to each evaluation was assessed by a criterion value set of the
of the variables presented in Table 5. There were four above-mentioned problems.
similar percentages for each answer and no signifi- Physical problem determination included evalua-
cant difference was found. tions of lack of physical energy, poor sleep, poor
Symptoms in the older adult were evaluated in order appetite, physical pain from no apparent cause and a
to define andropause assessment in the study popula- weakening of muscle strength. The score reached by
tion. The symptoms in the older adult/andropause the study participants was a mean of 0.83, corre-
sponding to ‘‘never’’. A SD of 1.08 indicated that
some patients answered ‘‘sometimes’’.
Table 5 Erectile function/response distribution
Vasomotor problem determination included the
Variable Meana SD N evaluation of feeling hot, excess perspiring and
Erection capacity 2.43 1.273 1,192 sweating and heart palpitations. The score reached
Erection quality 2.51 1.334 1,180 by the sample was an average of 1.39, corresponding
Penetration frequency 2.39 1.237 1,185 to ‘‘sometimes’’ for the general study population.
Post-penetration erection frequency 2.62 1.388 1,186
Response dispersion was greater in this area showing
a
a SD of 1.69, indicating that some patients reported
Value scale during the past month: presenting these types of problems ‘‘often’’, and
1 = I had no sexual activity others ‘‘always’’.
2 = Always or almost always In regard to psychological problems, the presence of
3 = Many times poor memory, poor concentration, anxiety, irritability,
4 = Sometimes a general loss of interest in things, nervousness,
5 = Rarely tension, feeling down, sadness or depression was
6 = Never or almost never evaluated. Study participants reported a mean of 0.70
SD: Standard deviation points, corresponding to ‘‘never’’ in the general study

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population. A SD of 0.90 indicated that some of the prostatitis patient had a risk of developing prostatic
participants experienced these types of problems symptomatology that was three times greater (3.079)
‘‘sometimes’’. than the individual who had not developed prostatitis.
Sexual problem determination included the eval- Although it was determined that there was no
uation for the following points: loss of interest in sex, significant statistical association between prostatic
lack of excitation in the presence of sexual objects, symptomatology and traumatism, the model indicated
no morning erections, and unsuccessful sexual acts that the patient with traumatism antecedents had 40%
with erection problems during coitus. The score more risk of developing prostatic symptomatology.
reached by the sample for these problems was 0.85, In the case of PE the regression model identified a
corresponding to ‘‘never’’. Response dispersion in the direct association between age factors and previous
definition of sexual problems was evaluated with a surgeries. Age showed a highly significant associa-
SD of 0.74, indicating that some patients ‘‘some- tion (P \ 0.01) with PE, and the association between
times’’ experienced signs of sexual deterioration. previous surgeries and PE showed statistical signif-
From the scores obtained with the Symptoms in icance (P \ 0.002). The individuals having had
the Older Adult questionnaire, 339 study participants previous surgeries were found to have a 55% greater
(39.5%) were diagnosed with andropause. The relative risk of developing PE than those study
remaining 60.5% did not have a high enough score participants who had not had previous surgeries. PE
to be considered andropausal. was present in 46.9% of a total of 1,011 patients,
Risk factors among the study variables were being more frequent in the age range of 51–60 years
determined from the database using a logistic (43.3%), followed by the age range of 61–70 years
regression model. This statistical procedure produced (26%). There was a 58% PE frequency in patients
associated variables and risk factors in diverse cases. having undergone surgery.
Table 7 shows the association between variables Upon analyzing erectile function, it was deter-
and risk factors for prostatic symptomatology, PE and mined that age was the only factor directly associated
erectile function. with ED. This difference showed statistical signifi-
Age and prostatitis were two important risk factors cance (P \ 0.033).
for the appearance of prostatic symptomatology. This Although smoking was not found to be statistically
association had a high significance with P \ 0.01. associated with erectile function, the individuals who
The regression model confirmed the fact that the reported having the smoking habit showed 11% more
increased risk of ED than those stating they did not
Table 7 Risk factors prostatic symptomatology, premature
smoke.
ejaculation and erectile function Table 8 shows the associations and risk factors for
symptoms in the older adult and andropause. Diabe-
Variable Statistical Odds
significance ratio tes diagnosis was directly associated with the
(P \ 0.05)a development of symptoms in the older adult, espe-
cially with physical problems. This association had a
Prostatic symptomatology
high statistical significance (P \ 0.0001). The model
Age 0.0001 1.047
indicated that diabetes patients had 2.29 greater risk
Prostatitis 0.0001 3.073
in developing older adult physical problems than
Traumatism 0.115 1.408
those without diabetes. Although no statistically
Premature ejaculation significant association was shown between HTN
Age 0.0001 0.947 and older adult physical problems, it was found that
Previous 0.002 1.554 HTN was a risk factor and that individuals diagnosed
surgery
with positive HTN had 22% more risk of developing
Erectile function
older adult physical problems than those who were
Age 0.033 0.986
not hypertensive.
Smoking 0.433 1.113
Regarding older adult vasomotor problems, no
a
Logistic regression direct association was found with any other factor.
CI 95% However, it was found that weight (excess weight

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Table 8 Risk factors older adult symptoms/Andropause the principal pathologies affecting the older adult.
Variable Statistical Odds
The reported results are similar to those of other
significance ratio clinical and epidemiological studies that have been
(P \ 0.05)a carried out in different parts of the world.
Taking into consideration a total of 1,316 valid
Physical problems
determinations of PSA, the average PSA in the study
Diabetes 0.0001 2.196
population was 1.73 with a range from 0 to 111. PSA
HTN 0.235 1.217
was done on only two patients under 40 years of age,
Vasomotor problems
with a mean value of 3.2 ng and no significance in the
Alcoholism 0.093 1.379
analysis of the other age ranges.
Weight 0.063 1.012
Regarding prostatic symptomatology, more than
Sexual problems
half the participants responded that they never
Diabetes 0.0001 2.305
experienced difficulty passing urine once they felt
Andropause the necessity to do so.
Diabetes 0.001 2.122 The final prostatic symptomatology score from the
Traumatism 0.003 2.086 international questionnaire was a mean of 7.96,
a
Logistic regression corresponding to slight symptomatology in the study
CI 95% population. Sixty percent of the participants had a
slight prostatic symptomatology score, while 9% had
and obesity) had a statistical tendency (P \ 0.063) to a score corresponding to severe prostatic symptomal-
be associated with the development of vasomotor ogy. From the responses concerning present urinary
problems. The risk model indicated that the relative symptoms, the average quality of life score for the
risk for patients habitually consuming alcohol was study participants was in the category of generally
38% greater for developing older adult vasomotor satisfactory. These results are very similar to those
problems than those subjects who did not report reported by Rosen et al. [23]. Prostatitis is a clinical
alcohol habits. condition which often presents with lower urinary
In relation to older adult sexual problems, a highly tract symptoms that are similar to symptoms caused
significant association (P \ 0.0001) with diabetes by prostatic growth and even lower urinary infection.
diagnosis was found. Diabetes was shown to be an Special treatment is recommended in these cases [24].
important risk factor for the development of older adult Close to 40% of the participants stated that they
sexual problems. Patients with diabetes had 2.39 experienced PE and of these, nearly all reported
greater risk of developing older adult sexual problems having it after sexual penetration. This figure is
than those without diabetes. There was also a highly similar to that reported by Spector and Carey [25].
significant direct association (P \ 0.001) between Over half the participants responded that the possi-
diabetes and andropause development as well as a bility of experiencing PE was not a source of anxiety
statistically significant association (P \ 0.003) and six out of every ten responses indicated that PE
between traumatism antecedents and andropause during their sexual relations did not cause any
development. These two factors were identified as risk difficulties in the relationship with their partners.
factors for andropause development in the study The average length of time elapsing before ejacula-
population. Both diabetic patients and patients with tion was a mean of 10.97 min in the study population.
traumatism antecedents showed a 2.19 greater relative An average of more than 60% of the participants
risk for andropause development than the individuals reported being able to have an erection ‘‘always or
without diabetes or traumatism antecedents. almost always’’ during sexual activity, with erections
that were hard enough to allow penetration, and that
they were able maintain penetration throughout the
Discussion sexual act. These results are similar to those reported
by Boyle et al. [26].
The percentages and averages of the urological Study participants had a score average of 1.39,
distress evaluated in this study give a clear idea of corresponding to ‘‘sometimes’’, in reference to the

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presence of older adult physical problems. In the case prostatism: a population-based survey of urinary symp-
of psychological problems, the score average was toms. J Urol 150:85
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0.70, considered to be ‘‘low’’. And finally, andro- ‘Prostate-related symptoms’ in Canadian men 50 years of
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to be present in 40% of the study participants. toms. Br J Urol 74:542–550
4. Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The
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Conclusions 5. Donovan JL, Abrams P, Peters TJ, Kay HE, Reynard J,
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The conclusion reached in this study is that prostatic ‘BPH’ study: the psychometric validity and reliability of
the ICS-male questionnaire. Br J Urol 77:554
symptoms in the older adult male are slightly above 6. Epstein RS, Deverka PA, Chute CG, Panser LA, Oesterling
those reported in similar studies. The largest percent- JE, Lieber MM, Schwartz SW, Patrick D (1992) Validation
age of patients presented with mild symptoms while of a new quality of life questionnaire for benign prostatic
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Society of Urology with the support of Sanofi Aventis and the doi:10.1016/j.eururo.2005.02.001
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