BPH and LUTS—
The presence of LUTS alongside BPH represents another important issue in men with erectile dysfunction. The Multinational Survey of The Ageing Male (MSAM-7) study — a multinational survey conducted in the United States and six European countries —
demonstrated that the presence of LUTS is an independent risk factor for erectile
dysfunction, although the pathological reason for this association is unclear9 . Common alterations in the NO–cGMP pathway, enhancement of RHOA–ROCK signalling and
pelvic atherosclerosis are often considered the most important mechanisms involved in determining the two conditions.
Psychogenic and relationship factors—
Aside from organic factors, psychogenic and relationship domains need to be evaluated in men with symptoms of erectile dysfunction. All sexual dysfunctions, even the most
documented organic types (such as diabetes-associated erectile dysfunction), are stressful and can lead to psychological disturbances101 . Performance anxiety is a
common issue in men with sexual dysfunction, often leading to avoidance of sex, loss of self-esteem and depression101.
Although considered less often, the quality of a relationship represents an essential determinant of successful sexual activity. In fact, any sexual dysfunction in one member of the couple will affect the couple as a whole, causing distress, partner issues and further exacerbation of the original sexual problem (see below)102.
Interestingly, a patient’s perception of reduced partner interest represents an independent predictor of incident cardiovascular events103. Hence, the physical relationship between partners should be considered not only as enjoyable, but also as a
strategy for improving overall health and life expectancy
