Clinical Briefs

By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim.

Sexual Dysfunction in Women with Metabolic Syndrome: Nutrition Intervention

It has been demonstrated that women with metabolic syndrome (MBS) have a higher prevalence of sexual dysfunction. Indeed, each of the individual components of MBS has been independently associated with greater frequency of female sexual dysfunction (FSD)

Clinical trials of the Mediterranean Diet as a secondary prevention intervention for MI have shown startlingly good outcomes, reducing MI by as much as 70%. Some of the benefits of the Mediterranean diet are attributed to improved endothelial function. Whether dietary intervention in women with MBS might ameliorate sexual dysfunction was the subject of this investigation.

This study selected women with FSD and MBS. Exclusions included smokers, a prior history of CV disease, any regular medication, and alcohol abuse. The Female Sexual Function Index (FSFI), which measures desire, arousal, lubrication, orgasm, satisfaction, and pain, was the primary trial metric.

Fifty-nine women were assigned to either Mediterranean Diet or control. The intervention group received dietary counseling, including a meeting with a nutritionist monthly for the first year, and bimonthly for the second year.

At the end of the trial, scores on the FSFI increased from 19.7 to 26.1 in the treatment group, but did not change in the control group. Each of the subcategories in the FSFI were favorably impacted. For women with MBS, utilization of the Mediterranean Diet may improve sexual dysfunction.

Esposito K, et al. Int J Impotence Research. 2007;19:486-491.

Confirming the Diagnosis of Premature Ejaculation

According to large population surveys, premature ejaculation (PEJ) is the most common sexual dysfunction in America. The definition becomes problematic, however, because DSM-IV criteria lack concreteness: "ejaculation before the person wishes it," or "causing marked distress of interpersonal difficulty." These descriptors are generally appropriate, but open to a wide range of interpretation. Even the amount of time prior to ejaculation which might be used as a clinical benchmark has been much debated, but intravaginal ejaculatory latency of less than 1.0-1.5 minutes is generally accepted as PEJ.

The Premature Ejaculation Diagnostic Tool (PEDT) was developed to assist clinicians in diagnosis of PEJ. This trial compared the PEDT with DSM-IV and actual expert clinician diagnosis of PEJ. Men with complaints of PEJ (n=102) were screened with the PEDT and individually interviewed by a clinician expert in male sexual dysfunction.

The concordance of PEDT results with DSM-IV and expert clinician diagnosis was excellent. Although clinicians may appropriately rely on direct patient interviewing rather than formalized sexual function scales to diagnose sexual dysfunction, the PEDT provides a tool that is simple to administer and accurate.

Symonds T, et al. Int Jour Impotence Research. 2007;19:521-525.

A Possible Relationship Between CAD and Colonic CA

Colon cancer and Coronary Artery Disease rank at the top of causes of death worldwide. A 2006 retrospective study indicated a strong relationship between them, some of which might be explained by shared risk factors (eg, smoking, diabetes, sedentary lifestyle, obesity). A cross-sectional study of residents of Hong Kong who were being evaluated for coronary artery disease (n = 414) provided the subjects for this report. From the large group of persons selected to undergo screening for CAD, subjects were divided into those with and without CAD subsequent to evaluation. Then, subjects were compared with age/sex matched controls from the general population. Participants underwent colonoscopy within 8 weeks, or when stable if an acute coronary disorder was present.

The prevalence of any colonic neoplasm was almost twice as great (34.0% vs 18.8%) in persons with proven CAD vs no-CAD. Specifically addressing colon cancer, the prevalence amongst the subgroup identified with CAD was almost ten-fold greater than CAD screenees without CAD (4.4% vs 0.5%).

As has been identified in other settings, smoking and the metabolic syndrome were associated with an increased risk of colonic neoplasia. The results of this study suggest that clinicians have a high level of vigilance for colonic neoplasia in persons who have been proven to have CAD.

Chan AOO, et al. JAMA. 2007;298(12):1412-1419.