Copii © Ho by Aaamcan Unotoca ABSOCATION me IMPOTENCE AND ITS MEDICAL AND PSYCHOSOCIAL CORRELATES: RESULTS OF THE MASSACHUSETTS MALE AGING STUDY HENRY A. FELDMAN, IRWIN GOLDSTEIN, DIMITRIOS G. HATZICHRISTOU, ROBERT J. KRANE, ‘ano JOHN B, McKINLAY* ‘rom the New Enon Rear Ina, Waren and Deprtment of Ul, Btn Unies Media Centr, Bi, Manoa, We provide current, normative data on the prevalence of impotence, and its physiological and ‘peyehovocial correlates in a general population using rests fom the ilassachusetts Male Aging Bi The Massachusetts Male Aging Sty was community based, random sample observational Survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1089 in ites and towing near Boston, Massachusetts, Blood samples, physiological masures, socio-demographic ‘arables, psychological indexes, and information on health status, mediations, smoking and life- ‘syle were collected by trained interviewers in the subject's Dome. A sel-aiministered sexo activity ‘questionnaite was uted to characterize erectile poten. "The combined prevalence of minimal, moderete and complete impotence was 525%. The prevalence ‘of complete inspotence tripled from 5 015% hetween subject ages 40 and 70 years. Subject age was the variable most strong associated with ampotonce. After adjustment forage, higher probability of impotence wat directly corelated with heart disease, hypertension, dabetes, associated medica tons and indexes of anger and depression, and inversely corelated with serum dehydoepiandros: terone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking tres associated with # greater probability of complete impotence in men with heart disease and Iypertensio ‘We conclu that impotence isa major health concern in light of the high prevalence, i strongly sociated with age, has multiple determinants, including some risk fetors for vascular disease, ‘and may be due parly to modifiable para-aging phenomena, "er Won nsec, pei rection. ey ene Impotence bas bien defined ss the persistent inbity to asians alain an erection adogate to perm salisatory ‘ul performance” Althoogh rpaded oben disorder, [potetee aes profund spect onthe alto ie of many ten" In the Untied Sates #198, petencencconted fot 400000 outpatient visits to_physicane and 3000 hospital ‘Amionmresallng in totl det cst of $10 lion ‘Despite the prevalence, costs and impliations of impotence {or suality of hfs, evrent normative date ot impotence in 0 ‘bay popostion are neil lacking, partial the inte of phisiclopea. and paychouocal variables The ‘Risry survey, conducted more then 40 fers agy in socal and medal content vastly dilret from tht ofthe present fas, romaine the ost extensive chased source af ‘ormntiv dats onsale sexual belo nthe United State” ‘Sobeequent studs have ben rstrced in scope" No com probeasive new dat om hally population exis o provide nestor the onserale advance ofthe last decade in oOF Understanding ofthe poesia mechanism of erect une ‘ion and datnetion™ Ttopotence in commonly asvocated with aging, Putative aust and ciel correlate of impotence, many of them Iikewisessncatd with aging, sce vscularinauticieney, torsional gerangement sntecrapsion of neural pathway, di ‘etn, pevshoqene factors end sie ects of herapeic drags Tha bon apie that impotence, ke earBovscuar disease Utnfother age rlted daar canbe atibted last poly trnoch modifiable pars-aging phenome "The Mansachusetts Male Apiog Study (MMAS), conducted search notte, 9 Galo ftom 1987 1989, was» community base, muliiscpinary firey of ealth end aang in te, incluting 4 private, sel ‘ministered questonnare on ser fpetion and activity. We ‘hed NMAS data vo mare the prevalence of inpotence in a ‘Boma polation of healthy gag men, to Geseibe the 29° tend of impotence inthis population, to determine whether sgerelted heath idee acount forthe age tend in imp {nce and to deny the variables absocated with impotence ‘rer and above the age end ‘Study sample The stay ample consisted of respondents 0 the MMAST® cross secinnal random traple survey of heal ats and elated vars in men 0 to 70 years old, The MAS" wan conducted from 1087 1.1888 Uy 11 randomly {tied cite and toms i the area of Boston, Masachuset, ‘Th scien of the MBAS has been decried previualy. ‘The MMAS sexual acvity quoionnaieincated 9 ems {elated to pency (at Append to which 1200 of the 1.70 IAS subjects (15%) provided complete responses, Theee 1280 men constitute te prevent stad vale (able) "To #19 excded en id ot ifr frm testy sample with repect to by ma nde, serum cholesterl smoking Tab lyse prevlene of heer: disease, byperten ‘Sony tcdcation use a ied sn table 7 ehnie dsebuton, Felton o membership in soil groupe In 201 cass the rasen {Srexcoron wn lack of a eazen eau priner Ee eonee: ‘quent nonresponse to deme 7 to 8 (ee Append. The exci fon of men mith no prter shoul hae te estinated prev fence of tnpotence domiwerd fatal nce ‘en Without frhers aut aly fo have @ greater than normal ate of poten The low prcentage of acsl minodeysbjetsTNSPOTENCE IN MASSACHUSETTS MEN 40 TO 70 YEARS OLD 5 "Thats 1 Pos, meta and nt donceipe chartrit of 1280 MAAS wats inci ado inte oan ne am) coping “icant — ‘ee {he sample (4%) was consistent with the composition of the Massichusets population Data elotion A tained technician std each sbi in his home, and completed the inetvie, carsrements and led sampling srthin those of hit swsenng. Inne ‘onsen was sbesined ne tho interview on we foray ap raved by an isttatinal eve bom oath status was ascertained by hing the sobjet cate sotig ist of dseaes a absent, tated or anreted Height ‘right and bod pressure were memured by andarion Tethods developed for Inge-scale ld work" Preciton Sod nonprescription modiestions wee gaered an tnvento ed by the interaewer. Two blood saapes wee draw 2 minutes spr and pooled for anal fips ond rx tra onmooee” Te psbeialogcalixtramont inloded meses tt dominance anger” and depress The sera ety ‘rsttonpaie was completed i private and returned to the ‘Cltraton study. The MMAS instrament was linked to & diet steam of potency by means of separate calibration ‘iy Men presenting at ou umierity medical center url ‘cline during -month pid in 1400 completed a que {nate consisting ofthe 9 questions Listed inthe pen Sodan adtonal question aking he espenent to characte. lar inset ae nt impotent minimally notes, snoderatey impotent or completes impotent able 2 stows tht slated Impotence wae reflected in MAS qoertione a higher ‘onncy of erected dug inereure, lower mony Fete serualsetvty and emtion and lower taco wh ‘ec life and partner, Accordingly, cuatate dberiminant formula, combining the 9 MMAS sel activity exponen 0 ‘rodce an estimate ofthe probity of each abt having Bil mipimal, moderate or compete impotene, wa constvted {roo thecliration ta by standard mtb ™ In cree ‘alidton procedure, vival allo the elibraton bjt (230 of tS or 94) were rela int the comet a fghcene category. The dseminant formula wae ape to MIMIAS dota Gwbun m diet seating of potency was ot salle) to proce storable: p prs py deseribing {ir each MMAS wibiet th repectiv lkeliod mint ‘ah moderate or tomplete mpenc ‘Site! onal Staple vomparsons bxtween the MMAS subject inched in our study aad howe exloded bec Imlay he hn eo sppropeate ‘To rite impotence to subject age, health aon 4d ciber candidate preicor vmiabley lta linear tain nd muvee anf apne ered se ‘rector Pid as the dependent vara Set age wat Incl ty obligatory cova in every anaes 8 that {ich independent vriahp wae meatus fd rie pone ve a ie ‘pendence of ps bon emtnuoas Independent at es. ich serum celeste. The maleate ull pot i oo snciaton wth any dre of impotence) as ested srithasinele statistic (gree of eedom infinity) flowed Uy eraminaden af the unariate eresons of Py pepe shen Stent muvee eda Tate" anabjeis of variance war smiary teed to. compare Ppspip. across tgorie of diene aa tmoking bebe ‘tnd diction us. Stated Analy Sytem procedure or the geeral incr model were wed for mara neat Fegresion and mltvait analyse of variance When dati {ila pee trac wen ch cto re {ors pe pltaned fallonup comparione were ade betwetn ‘sppiopiate adjusted robproup means, All erences ot {he presentation of rete wore satay sgnieant at P eat Prevalence, Summary satsties on the prevalence of i mina moderate and complete impotence re own in abe 8 nthe etre sample of 290 pen 40 ta 10 Seal the Bee dere of patency w (Genoa ero The largest category was moderate inposnce vrthna 252% prevalence, the ner largest wa nial ipo (epee a 172 and the ets was Compete mpenet S68 ‘Age dependence The rations of impotence probailites tothe age of MAMAS sujecte ir iweratedin gure 1. Between sitet ages of 40 and 0 sears tbe probaly of complete impoteee tripled fem 5.1to 5%. wale the probably of ‘molerate impotence dbl rm 1 034% Within the ane ‘ge range the probability of mininal impotence remained con fant a appronately 17% An eeimated 80" ofthe en ‘et ok tnt a 4a potent at age 1 years. ‘Whenever age was tested by multivariate near regression or maivarste sain arian conpacion with ane56 ae BS cope i 4 Bortoccar am sta td uh ein, “Tan 2 Slated inpetens in cettion ample (09 uj rte vex ety usin from MAS IMPOTRNCE IN MASSACHUSETTS MEN 40 TO 70 YEARS OLD ‘ml wen ang ee chiens EBs, icone ———_ a ey axon Sa oa ese eee ‘reds arene Ee oo os PROBABILITY a. Amcitin of ule! ap with pri of impeene snp iin pain ab ponents owe ot Piocthans ok impotence age invariably proved tobe statistically Pieiieant at p c.00i: No other vanable, whether comelated ‘rb ae or nat dainisned the predictive pone of ebupe age. ‘Dssve Cen treated medical condions, incline i es art dae a person ree ict ‘ated with changes in the impotence probability pattern afer ‘Sthmtment forsubject age ig?) he age aysed probability {Sr complteinpotence was 285 in thowe mith eted abe, So Tou hese hens anand 12 a sew {trated hypersnaon, compared with 0 in tho entire sam UUnteated decam as asecated with impotence in 9 other ‘condisons antented ler (08%), untested tie (10%) {ind untested alengy (128, “Lpde The probity of impotence vied inversely with igh density ipoprotein cholesterol. Fort Songer men ae {to 88 yearn the agesadhusted probability of moderate i= Dotece inereaed roan 6 to 5° ae high dealy hpopeoain fneteral decreased fom 0 to 90 mg/l) Tate ser ten (age to 10 yeas), th probably of compet impotence [Rerened from near ero to. 16% 08 high dent Tipprotin ‘Shoerteol decreased fem 00 to 30 ng. Tota serum cho er wes not comelated with impotence probabilities “Hormones Of he 1 hormones measured in NMAS ub, only te dread andogen metabaie dehydrorpandiosterone apt ii refine outa savy trina of AS tte showed a trong correlation with impotence i). The je proba of complete impotence increased fom ‘coat as dalodroiandrateroe slate decreased from oo G8 gee. Dikrdotsoeterone and corsa showed «f- face of wal maguitide on minimal impotence only. Noe Festion with imptence wa ond fortesoterone (ibe ee, ‘busin bound or toa), sex horsone binding pobulin (he ‘ajor scram cre atsteone), vais ber androgens fd tetaoler inciding anortenedine and androsane ‘hob, estrogens, roan or the pituitary gonadotropin (ol liclestimuating hormone and leiniing hormone) ‘Medications Comlete impotence was signifeantly more prevalent isbn taking oan medications including hype ovemic agent (25%), antngperensives (14), eaodlators fees) and candnedrge (28%), than i he sample asa whole (8.65, ig 4) The prebablity pater in user of podem gents clely reveled that in eobjets reporting tented Alshees, Litewisn, mon taking cardiac drugs or acihypertem ‘iter showed a pette of impotence probabltessimiar to fhe in men reporting treated heart dea or hypertension, "The probity of mederate (128) a wells complete (6%), Iipotence was prtisany gest for men akg Vso,[IMPOTENCE 1N MASSACHUSETTS MEX 40 70 70 YEARS OLD Cum Cis soe See <=] 3 ei ofp eh epi ty aot heat ame tee Secs peanereaenee Soe ere acct atc oe ‘nlfote" DPF dnpdrotetoseone aa Dioove fice cat copie Pe. Aun of mei nag ied pio ‘tal ecieyqwstonoave of MMAR. ae No comeletion was found between inpotence and the wie of Tpi-lomering or sympathetic dru. "Cgereie ooking The ston impotence with certain factors was gray spified in event igarete sneer ulate with rented heart ses he ageadusted probe Dity af compte impotence wax 36% for corer ees, omar ith 2 or et robe Aone ed Iyperepsives those who cuzrenly seoked cigretes fod an cleeated probability of complete impatence 30), whereas the onsrokers (85%) were compare to the geberal sample (8%). The caren makers mith ortreated etheie had Sgnicanty greater probaiity of camplece impotence (20%) {han the nonstokers with that condition (245, ‘Dag etfects or ls exacerbated by current soking, Cor rent irre smoking ineeased the age-adjusted probably to eorplteipotence in thove taking cards drug om ML to 415), antihypertensive mericetions (rom 7810 20%) sod ‘eaaiors deom 21 to 525), Pa A genera tet of current cigmtesnioking wat ot ted he rabality of complete impotence was 1% i abakers and 83% in nensnoker (p >020) Among curent smokers, Impotence probabilities. showed. mo dependence on dosage (Oacks per day) ar let pack-years soe. No significa Alerence was ncted betwen asc who reported expose to caret snake at homeo at work and tice wh reported “je sole. Probabitis of mpotence were nt dependent on brane index (weigh Sided by bet sae) or aise. {hip ratio an index of at Ienkastion The impos prob tity patton didnot aie signeonty betwee sate ho were rete than 190% of sea weight” and thee wh were ot Bresrive alcohol consumption (ore than 60 ml pee (week) war scat with intesed probability of eine Inpotence om 17 0 29% (ig 3) A quantlive estimate of Ait lechol consumption was sims conelaed with min ‘mal imptenc, os was a mere of bod snl content based ‘on daly consumption id nonsliae for boy max, "Pechlogal dees, Soppresion and expression of ange, ss measured by the Spielrger tds, were coelted "ith Aiher probit of moderate and complet impotence (i B} Mon with mesimum level of snger suppression sod snget ‘expression showed an agt-adysed probity af 9% for nod trate impotence and 16 to 19% for compete inpsonoe, oth Wall abore the general ee 8.6%). "The Jackson velo of dominance, measuring foqueney of ‘ntmpi to cone one's environment and tnluens ther, {id the Center fr Epidemiiop States preston ale ware stony ited with intone ig) At the esi Impotence wae 15% lcompared with 25% generally) tad he Brcbbiity of compete impotence was 7.0% (compared with 5387) Arthe manimum degre of spresson the comin age ‘adjusted probity af either moserate or complet iapotence ‘eas nearly 907%, compared wit 5°03 mid sl and 2 at {he est depesad exten, Coho Efi Ewe cemtee J tein sere naman bi teres See anes eae phot rene cee ANGER EXP epresicn of sper. ‘woresion of saeMethodological mens, The MMAS was based on sample of noninstionalised men with age strated un Formly between 4 end 10 year, ony faction of whom were Scand undergoing medical care. By ontas, ere sade ‘sf ipotence ere ited to ten fom eutptent clinics" ‘der populations" or other selective souren* The IIMA fesonse rate (59) vas similar to thowe achieved in ‘ier comparable epidemiological stubs involving in-home ‘phlebotomy The representative natane ofthe MMAS dat was oan in a fllonyp study of 400 ronrespondents. The ‘ved sample ie 1709) was ger than at of any sty in the 40 youre ence the Kineey el morn? By making in one measurements MMAS voided sifactaal buses that Commonly rule from interaction of the abject wth the ‘tetra sytem, The MMAS inventory of mization was more ‘curate han ia posable na lini based study. Tae compre: fensve MAMAS hormone and lpi prole represented bas ‘aon controled for poate emtaions and diana vation. The snerbed ogre of impotence inthis study wasbmsed om tule responses to a prtvately seladninistered question ‘ie, eather than on a designation by th phic. Poteney ‘te iddresed na mjeeive sate” as opened to the more ‘Gunewetly defined phenonenon of erectile dysanction. Recent ‘Gta sow that mane fraction of cass o vce dtunetion {he organism ogi tnd Tel from hemodynamic, mera fh endoerinolepesl drug-related or other undefined factors? Poiency, defined a satntacoryfonetioneleapaity for er thon, ny coexist with some dares of erectile dyfonetion in the sea of suas git or smaximal expel to beta the arcion* Theefre, impotence is best defined by {helpeivefelvmmcrctn ofl umssicuton bsp terme ‘trminimal, moderate or complet nptence as presented to 8 Dhyscian for testient* Stati val f this approach Xo caterorsing impotence wor etabliahed by cos validation ‘four eaibration data ‘Proaence. Inthe MOMIAS sample the prvalenee of impo tence ofall dagrees was estimated at S2%. Projection of these ‘ess to 1990 population data would sugest hat potence ‘ist 18 lion American nen 40 to 70 ear ol. Therefore, Itpotence shoal be considered a « major lth concern. Published information concerning the prevlence af impo tence has ben lite in scope and weefulnns "Among the {ew rpora in the gece Lterstre the ceria for defining Inpotence hare varied, while he methods for abtaining sty popeltpe diced and prevalence ures mere at strated Byte!" Slaget ol found tat song 1180 men attending 2 nude outpatient line 85 reported impotence to thet Interrners! Sein et al reported onthe base of dead ‘qoetionnazes, atthe presence of inpotence in 212 fay ‘rate palin with mean ae of 6 ear was 2%" Morey ser a prvalnoe of impotence of 27% in men more ‘han 50 yeaa od undergoing» general heath screening Diokno el reported» 40% impotege fat in 283 nonin {Stina em ola than 80 yeaa ‘Ae ond. nthe MMAS szpl, ce probability of complete inpovence tripled fom to 19% between sje age of 40 find TOyears Nother varible whether or nt asocated with ‘npovenee, could secount fr the lfct of che simple age ‘unable when bath were tested joy hy rereson anal ‘Poor staes have shown sala elatonshipe between i= otence and apne, Kinoy eal ound inpetence tobe an abe Uependent doves wh x prevalnce of 19% a age 0 yeary fu 26% age GS yearn Staies by Pearlnan and Kabah” rane a and others in Ue 1970 have shown impotence felted age dopendenc. ‘The Baltimore Login Study of ‘Anngceportd that by age 69 yeas impotence was problem {Sr of al holt men, and cet frees 5,75 and BO years the prevlneeineesed to 298, 55% am 75, reapeciely™ IMPOTENCE IN MASSACHUSETTS MEN 40 TO 70 YEARS OLD eifer and Davis obese in 261 men that age was negatively ‘lated with erent exual function." In 225 get cine ‘ton Muligas et found thereof impotence tobe 25% Stage 65 sears and geunge,. and 50% at age 70 eats and der Rell eta wadying wléroportd sexual funciton nthe Chataton Hear Std Cobo found the rte of eal nae- tivity to be 205 fn menage 0 to 6 sears and OO a age 80 eats and oler" Heigtening the importance ofthese data is the fact that hy the year ves current trend 20% ofthe United Sater popalaton wil be more than 65 ars old ‘Moreover, ie expectamy for mon wining age 6 Seas as Ineremaed aabetatily this entry” ‘Dabte: Disbtan awl espa bss associated with inpotenc, Inthe MAS sample the age-adjusted probability tf eomplete impotence nar tne restr abjecte reporting {teed diabetes than in thoe witht diabetes. Other invest {mors pray using exesvely dete populations, bave pest founds hh prevalence of impotence aseiated ‘kdb with extensor ranging fom 35 to 50% and {o'7ec The provleee af pone in diabetes a ees ‘sported to increase fen 15% at ae 0 to 4 year to 8H a oe Ob years Onset of hnpotence a reported to esur et an flrber agen persone with Sibetn than in the general pops ftton, rxuettiy ladle to or following within 10 year te ‘dgnoas of ehabeto,whelbue of the insulin depenient ot ‘oninsln- dependent pe: "We rserchersdaage ato which ofthe many pete of diabetes the dictenie of mpotenc, vascular dase is ‘st fewenty ied. Zeuel reported that 40 to 30% of men ‘ith dnicter ad hypertension noid sexo dysfunction but ‘Taps thee was do npr to heir edeatons” Several {petlgstorsbavefoud high rte of sasclarsbnormales {R'jauenes nim cabeest aed gyucnepteae n pte lan Other factor inplcted in Gabel impotence cle ‘Soocated sotonomic suropethy and gona djtonction ‘Sten de Tejada eal snowed that diabetes pais neurogenic fd eodithelim metied relaxation af pele sooth mis Iason, hyeriensn d low sro high denstyHpoprcen, were sgcantlyorelted with impotence in the MMAS ‘Shove Te tay be inred that vase compromise, a r= Fectad in caiovsclar or cerebrovascular cae, hate ‘Snmvn deterninants ith vseular impart of terete {nowtanlsm. The nsosiaon of mptene with vaca eae Inthe literature sng inpatments inthe Besodamice tterction pave ben onstrate inpatients with mead Infarction? coronary typase -nrgery™cerebrovasclar ‘events and perpherl macular doce Thee stds ‘fee performed primary in impotent adil subject: Oaks Ini Moyer forexample reported that to 10% ofall untreated Ipeteneive paint tre impotent t dagnoss of hyperten- ‘lon! Wabrek and hchll ported thet smong 131 men 31 {0 8 years old who wae howptlnd foray aca mycoardal Infarction 4 ere impotent tna ety of pllents who Uunerent coronary ery surgery S7% mere toll impo tent Several asses impotent ten reported hat dem ter of sbnormel penile vascular findings iifeatyinresed tren history included myocarda nario oval Fk Tictom, such a yperension and cigarette smoking" ‘ther discases Bale etal reported impotence among pa tiene with arta” ko MMAS the asecition was specie {Seigarette smokers No data ex in he lterature conning Ipotence in connacton with uler ovary bach of which ‘hed sal fot ngpeant elects in the MEAS spl ‘ormones, "The eit of stdrogen on hide and sexual ‘cherie ell elie? but thir fet on the erectile ecinnsm nod their contin to impotence rerun ‘Sear he value of routine hormone serening reais ntoverial™" In NMAS, of 'T bormones measured onyIMPOTENCE IN MASSACHUSEITS MEN 40 70 70 YEARS OLD dekydonpingdrsteroneslfte was roy anointed with impotenes Posobly relevant the reputed pret val of deksowpiandrstrone sulle for crdovauelar sae™ or the fc that serum Sehroepiandronrone alate concent Won decent more rapidly with ape then many eerste Paty ‘Mecicavions, Most studies dcumerting dr induce impo tenes have ben subject, apd bacon repr ncn tell studies and einical impressions Morley nied that 1a the 2 mort widely prescribed ron the United States have been reported to eso impotence Slag etal ound ¢ 25S prevalence of drugausoeuted mpotenes tn medial utatiene poplation Whtchea! and Rie rporied shat Sxpoebeemie rerling fom inula or eral Iypoegeeme sernincon ease erect or orenmiedahincion Mabe rua Secon he ben sce ith ial vey salle Snulsperenave agers incadingermpsthobic,»sdtencesp Aor ilocking agents vsodlatont and Gureten=== ‘nthe MAMAS data, which incuced a complete in-home idan iveror. impotence wm seatstclysurated ‘neh ancpertensive,vasdier cde and hypeemic ‘Bedieaton: in ths oberon sesng he dg eescitons ‘ire necro confounded with he uerpng eal con ‘Bion. Wein abd van Arden reconmendd tat the dng Sons of drugnduced sexual dovunstion be vetted tos ‘eoredcible ovoid ee tha dsapears on aco Inthe drag’ A much age rw es cotrled sty in tical popuistion would be requredtoetablh any spect ‘neicaton ss extatve “ies, Cigarette smoking ba been shown tobe an inde: pendent ik facto fr vesclogeni S Ms curen sgmetic whinge te i of ‘otee esociced wich cardivascd dss and eda tls ie influence on sexu fet foe bean pt tet such x ecesve alse consumption, ovaty and ob ict nativity in untea’™* We fount no creation teen Impotence and obesity, and only alght stern ith ‘trol in MMAS vtec ‘Paocolgel actors Peychologclexplantions fo impo- {eter mich are common in popula oreptonn and nese stoves" havea specific psolgea ban, While perch sie sinull normaly failtate erettan, eebal spe ean rode impotence equally wel by ihibing refer scvaion fab parapets ctor eres tat enhance inflow of ‘od tthe pein” ‘Te MAAS the peyeoloies factor strona assorted with Inpoteneeincaded depresion, tw el of domnance and steer ether expressed outward r dveced inward Chal Suvest consistent doeumene decane intra in seal Setiy in 6 to 90% ofall dered indduna* Howey fd expen of mgr ave anocaed ith ony eae besser, such a pent ler and corey diese = * Exes ‘cement al ted by ee wx ‘onal pectonlity trite and probes with expression of ‘trations, parielarly anger Pathway of moan noone “len enone theve apeologeal tacore wth sera perfor tee, Broce sympathetic autfow or seated Bod et. ‘choianie les an announ nGial may proce vo Sensi and nceae penile oot mace tne opponng the events necmary for erection * Convery aman who bat txperenced recent pattern of ence dysunction ray be {xpeced to be aio, depressed and lckng sltetem and ‘elreondene. “Inplaton: Impotence ia highly revaent health problem vith considerable pact on the quay of eof ging shen Our sad produced normative date ailing a strong ed in the preven of impotence betwee age 40 and 0 year. Several nariblen including cigeete woking and stor isk {etm for velar dient, showed eatally nica ‘Seclaone with impotence ve dl sbowe the ng end: We 59 infer that impotence maybe du party to modifiable pate feing Phenomena. Publi Meal policy and eieal manage ‘ont directed the modifiable fatoresucesaed with impo tence could remit in sanican alleviation ofa coy end Durdensome problem o aging Dr, John W. Rowe an Dr, Christopher Loneope eantib- ted to the development nd condi of the Mateshusete Male Aging Std Sexual activity qustions rated to potency, fom sad ministered instrament icded in MMAS Minn were mek, Now etn Go You usually have sexual 1 enter number n box) 2, Daring an average shou dy, how often do you have full ‘ard erection? {eter number in box) 8, During the last 6 months hace you ever had trouble geting [zn ren before interes Bois No, BY Have not had seal ntenoourse within lst 6 mont. 4. sing he it nt ave yee ha abe hein No, Bes Have not had sau intercourse within lst 6 months. 15. How tnguenty do you awaken fom sleep with fll erc> ‘Daly © Once won 1. 20r5 ees per month, © Once a month {Las than once per month Not at all with the at 6 month. 6, How sated are yu wth our sex le? 'Rxtomely ated 1 Somewhat stad € Netter stated nor dati 4 Somewhat diratrted se Brtremelydaatisied 7. Hor eased aye ou with your sexual relationship with ‘our prsent partner or pores? ‘2 Beremely stood 1 Somewhat steed © Neliberetinied nor dais 4 Somewhat deed f Prcremel disaisi 4. Hlw sted do you think your parte) ie (are) with your ‘mul alton Extremely ated Somewhat stab © Neither sti ordivaised {1 Somenbat deste Batre distin 8. His the frequency of jour sexual activity with a pertner fas much a your deine? Bes than jou dese? ‘more than you desire? 1, Imps, Nan Iie of Hea Conan Sateen 2. Kran Cle el Sao Talis Now ig Nad 321 4. tna Centt for Hey Sait: Det Dinos and ‘reece or Pats Dachaged From SS Heap ‘Usted Sue, ioe Hater; Mayne al nd ehSti spi 18, No.9 Und State Deze Hel Haman Sere Pobteton Na PHS TO, 18, 4. nm, MEME, Woman, Bis Creme Sy Hemmond 8. cece, Mi Spark RP aed Saul Tongs {soot fl ton song te mie eens ‘Gentacsng lone dete Ne duct Med, 18. 5. iy, Pao, W. Bad Manin, Se Behar ‘te fan Mae Peep: WB Saupe Coy 18 6, Sack We Grech Cy Aare Avent, Dy Cat "Fis tala HG. nan Bs Normal Homan Ang ‘The Bamere Loggia Stoo Age Ratio Inter {feats Pectin No 4-9. et November Lt EP et ae ae ts tang fly practice paciests Fas Pra 1, 288. a rane'E ult 2 Reon B Png feel “Sfacion in “ocr” coupes Ne Engl} Med, 3081, 8 Reng, A Band Wi, WM: An ato elt mported “tu nhvior in sample mol aes Ach Sex Boa seg male Henk of ei, Smal cee in Sowigy. Bed ty 3 Maney und Hap New Yor 11, Sap Fey. Blom MR Tey, D Nel, SE Reina AE: Kina, WB Raney A'S" Neal FG ad Since Rf notner nein cateonpasents JAMA, 240" [rm im Moly tence goer me, Han: Prac 23:88 1988. ali, Suteand 5.8 up. RO. Was Rand Chey, ‘PEs Sa npuel swil ois neck od Woes the CUarton heresy oxpnenc 1 Aging Hel ins Hy Vero, A. and Wang, M.S: Sens! ear in etn pm. Orony on 24 Smo 1, Verwoerd, A Peer aed Wane, HS: Sena in “omens Peso sual siya res Cs 16, Dolo, AC, Brown, M. B. and Herng, AR Seva faction sit ria Se eer eae By Mee eevee act fins mie he, Caceres Rais arc Seana et ope an sy wap ca Caters tans Lettamerc te Ee Ramet mneabcear tears sae an ot ietittacmetaarnn ments Sopa chavmeencea ose ‘peitaae teams ea, Senay Pieusatt ater CEE ae een cet ‘hunts Mle Aging Stuy Tr Prceting of che cA eee a Peer MER, SRL, Kipp, D. ME Jekoen, P Downes and Catton. RASA eid apathetic bial ad ean: Prosi th oureh Conference Hath Survey Resareh Math Washo, Does Und Eterm of Wath st Yona ncn Pten "Pevh ope 40°68 1977 hy ies: 2% Spier ©, Johnson, BH, Rose .F, rape, HJ IMPOTENCE IN MASSACHUSETTS MEN 40 TO 70 YEARS OLD ‘et And et: Th ni nd nn age crt dc tee oes Srna ites cee Siaebecimoees Rec ae A er era na Ee a ee ssh parca hha rin A ae thie DK, artis i tata, 2 Cato Searels fee Sacto se OF Ae tn Nr Yo ho Wy SARTRE FE evn, a, ca AeA enn ahaa il ie Pama i acento es oe Feat ee NE, «nt bn, aces rer em re senate Art te, Be Fy woke Cerri a soron Tisha 2 ante a i Se Ss at CaM snl nd ra fe i a eaten tt eee pany of ne set ohn Dn ti St nus 6: Bseemnants of senator at OS ‘ica ti Nong Sep care A eee ie et ei cis ma Ee Seis eae aes ae i een AC Seth AD rn icon np Ue er rena Dg ton [MéCullach D, Ke Canpbell Wy Wu F.C Peo Jad ‘Sant fw aloe of at ten Dain perez a le Bs Horm nd Call WP Ralf het iraq barter he Fring muh Ae 5 ‘Labtean, FP. apd dacs, J A Euolgy of diabetic impotence. 3 Jesh, Mer, Bion Magnus, WD, ad Here Yee ior oct rs ts Us a men tae Re et ihn, WA pared en an ng Sehe Were eme snags sets (oie ae aa cB ert te cam are enor Apel Sit, Cl sean tution ae eke Cr a re ee Snare Minit ree oA re Seman te EE eee er saan 1 it iehomge en te eh Sees ieoncmeen ar Sree a[MFOTENCE IN MASSACHUSETTS WED 40 70 70 veARs OLD o ig ry rn cea ee st Ctbon comme 67, Bley. 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