Synopsis of results from European male ageing study

The European Male Ageing Study (EMAS) investigated the age-related changes in general and sexual health in men in eight European centers (non-transitional), including three from Eastern Europe (transitional, where socioeconomic, political parameters are evolving).

SUMMARY OF FINDINGS

General health

1. The prevalence of lower urinary tract symptamatology (LUTS), nocturia and treatment for prostate diseases was higher in the older age groups and nocturia was higher in transitional centers.

Lifestyle and quality of life (QoL) measures

1. Both smoking and alcohol consumption showed an inverse relationship with age, with men from transitional centers more likely to smoke and consume alcohol less frequently than men from non-transitional centers.

Frequency of sexual activity

1. Frequency of sexual intercourse, kissing and petting, and masturbation was lower in the older age groups.

2. Concern about sexual activity was higher in the age group of 50–70 years.

3. Overall, no differences were seen between transitional and non-transitional centers for frequency of sexual thoughts, concern about frequency of sexual activities, petting, and intercourse.

4. Conversely, subjects living in non-transitional centers reported a higher frequency of masturbation.

Prevalence of erectile and orgasmic dysfunction

1. Erectile dysfunction (ED) (moderate or severe) was reported in 30% of the entire study. The prevalence of ED was higher in the older age groups, peaking in men 70 years and older (64%).

2. Among men with ED, concern about ED was highest (57%) and lowest (28%) in the 50-59 and ≥70- years age bands, respectively.

3. > 50% were satisfied with their sexual relationship, while 83% were satisfied with their nonsexual relationship, which was independent of age.

4. Although men living in transitional centers reported a higher frequency of ED, they were less concerned about it as compared with men in non-transitional centers.

5. In addition, men in transitional centers reported higher levels of orgasm difficulties (66% vs. 75% reporting they achieved orgasm ≥half the time) and lower satisfaction in terms of timing of orgasm.

Relationship between sociodemographic parameters and ED

1. Current smoking was a significant risk factor for ED.

Relationship between morbidities and sexual function

1. Depression affected all aspects of the sexual cycle.

2. LUTS were associated with ED and orgasm frequency.

3. ED was also influenced by cardiovascular disease (CVD), diabetes and obesity.

4. Finally, CVD was also a risk factor for the frequency of sexual intercourse.

Relationship between health/lifestyle factors and health-related QoL

1. CVD, depression, LUTS, obesity, ED, and hypertension were independent predictors of low physical QoL.

Age-Related Changes in General and Sexual Health in Middle-Aged and Older Men: Results from the European Male Ageing Study (EMAS)

Giovanni Corona MD^1,2, Matteo Monami MD³, Valentina Boddi MD¹, Daniela Balzi MDC⁴, Cecilia Melani MD⁴, Nelli Federico MD², Daniela Balzi MD¹, Alessandra Sforza MD⁵, Carlo M. Rotella MD⁶, Gianni Forti MD⁶, Edoardo Mannucci MD³, M. Maggi MD^1∗ Journal of Sexual Medicine, Volume 7, Issue 7, pages 2538–2546, July 2010.

COMMENT

EMAS is the largest multicenter, population-based study of aging in European men which has allowed us to systematically analyze various aspects of sexual function and ED. The major finding of the study has been that the overall incidence of ED is 30% and 60% of men between 50–60 years are extremely concerned by ED, with concern for ED increasing with socioeconomic development. Organic determinants and, in particular CVD risk factors have been considered the most important pathogenic factors underlying ED, additionally, obesity, CVD, diabetes, and smoking represented risk factors for ED. Further, developing countries are likely to have a higher incidence of prostatic diseases in the older age group, with employment rate and perception of partner's health as independent risk factors for ED.

ED is also the only sexual parameter significantly associated with an impairment of physical QoL. Although ED is prevalent in older men, concern about it decreased after the sixth decade with a significant proportion of men over 70 apparently reconciled to lower levels of sexual activity, though sex remained an important part of elderly people's lives. Overall, a decline in all of the sexual function domains (erectile function, libido, ejaculatory function, sexual problems, and sexual satisfaction) was reported.

Men from developing countries appeared less concerned about ED and more satisfied with their sexual relationships, possibly reflecting attitudinal and/or cultural differences in these societies. Recognizing underlying conditions through ED might be a useful motivation for men to improve their health-related lifestyle choices. The presence of ED, previously considered no more than a frustrating condition should now be regarded as a unique opportunity to screen for the presence of comorbidities. Hence, ED subjects can be considered in some ways “lucky” because ED offers them a chance to undergo medical examination and therefore, to improve not only sexual but also, most importantly, overall health.

EMAS data demonstrates that as men become middle-aged and older, they remain sexually active even if sexual dysfunctions associated with comorbidities are more prevalent in older age. The economic situation in countries seems to be associated with a greater impairment of sexual function and lower QoL due to prevalence of concomitant morbidities. These data provide new information regarding the complex interrelationships between general and sexual health and overall QoL in aging men. A greater understanding of how these relationships apply to different countries is important in the provision of comprehensive healthcare for the burgeoning elderly population and to plan more effective strategies to promote healthy aging for men.