Male Sexual Dysfunction Prevalence of Erectile Dysfunction in Men Screened for Prostate Cancer Fernando J. Bianco, Jr, Benjamin R. McHone, Kristopher Wagner, Andre King, Jacqueline Burgess, Steve Patierno, and Thomas W. Jarrett OBJECTIVES The Sexual Health Inventory for Men (SHIM) is a widely used scale for the screening and diagnosis of erectile dysfunction (ED). Our objective was to incorporate the SHIM into our prostate cancer screening program to estimate the prevalence of ED among men screened for prostate cancer. METHODS During September 2006, men younger than 75 years of age living in the Washington, DC area were invited to participate in the George Washington University Prostate Cancer Screening Program. The SHIM questionnaire was administered to all participants. Information regarding primary care physician use, phosphodiesterase-5 inhibitor use, serum prostate-specific antigen levels, and digital rectal examination findings was also obtained. Those who registered SHIM scores of 17 or less or who were taking a phosphodiesterase-5 inhibitor were considered to have ED. RESULTS Overall, 333 men attended the program. Of the 328 men, 123 (37.5%) met our definition of ED; 30 (9%) were using a phosphodiesterase-5 inhibitor and 93 (28%) had an SHIM score of 17 or less. Univariate analysis suggested a significant difference in the prevalence of ED between African-American men and non–African-American men, with 25% and 41%, respectively, found to have a SHIM score of 17 or less (P  .01); however, this difference was not significant once we controlled for age (P  .05). Among our participants, 33% lacked a primary care physician. Of these, 22% had a SHIM score of 17 or less. CONCLUSIONS The results of our study have shown that ED increases in a nonlinear fashion with age, consistent with the findings of previous reports. Of greater concern, however, given the strong association between ED and cardiovascular disease, was the number of those with ED who lacked a primary care physician. UROLOGY 74: 89 –93, 2009. © 2009 Elsevier Inc. A penile erection is the culmination event that reflects neurologic and vasculogenic responses to psychological and peripheral stimulation. A Na- tional Institutes of Health Consensus Panel defined erec- tile dysfunction (ED) as part of a complex, interrelated sexual process involving a consistent inability to achieve or maintain an erect penis that interferes with overall sexual satisfaction. 1 The introduction of effective oral therapy in 1998 changed the paradigm of erectile dys- function as this problem gained industry-sponsored awareness. It is now common to encounter media cam- paigns encouraging men to become familiar with this common problem and encouraging them to seek medical attention. Furthermore, epidemiologic data from 2006 and 2007 have suggested that ED is a very early sign of endothelial dysfunction that anticipates the manifesta- tion of a cardiovascular life-threatening event. 2–5 The introduction and validation of the International Index of Erectile Function provided a formidable tool to understand male sexual function status. 6 Furthermore, the sum score of critical questions from this comprehen- sive index, called the Sexual Health Inventory for Men (SHIM) has served as an objective, efficient measure that identifies men with compromised erectile status. Its un- canny simplicity, yet accurate assessment of ED, repre- sents a particular advantage of this tool. 7 Prostate cancer is the most common solid malignancy in men living in the United States with more than 200 000 men estimated to have received this diagnosis in 2007. 8 Since the 1990s, prostate cancer screening cam- paigns have become common events at health fairs and represent the “hallmark” action of the Prostate Cancer Awareness Month. Although the definitive survival ef- fects of screening are still a matter of debate and subject to a randomized trial in the United States, positive sur- vival results have been reported in Austria. 9 The Amer- ican Cancer Society has advocated screening for men 50 years old or older, unless they have family history of This research was funded in part by an unrestricted grant from the Amgen Foundation to the GW Cancer Institute, George Washington University Medical Center, Washington, DC. From the Department of Urology and GW Cancer Institute, George Washington University Medical Center, Washington, DC Reprint requests: Fernando J. Bianco, Jr., M.D., Prostate Program, Columbia University, Division of Urology, 4302 Alton Road, Suite 540, Miami Beach, Florida 33140. E-mail: research@drbianco.org Submitted: November 25, 2007, accepted (with revisions): March 21, 2008 © 2009 Elsevier Inc. 0090-4295/09/$34.00 89 All Rights Reserved doi:10.1016/j.urology.2008.03.036