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We sought to compare the demographics and fertility characteristics of men presenting to reproductive urologists (RU) for evaluation in the United States (US) and Canada using data from the Andrology Research Consortium. A standardized patient questionnaire was used to prospectively evaluate men across fifteen North American male infertility practices between 2015 and 2018. Patient demographics, fertility histories, including female partner infertility testing and treatment, and referral data were assessed. Univariate analysis was used to determine geographical differences between the various patient characteristics and the geographical region. We sampled 6,462 men with a mean age of 36.6 ± 7.5 years. The average duration of infertility was significantly higher in US men (4.5 ± 7.2 years) compared to Canadian men (3.6 ± 4 years) (p = 0.007). Significantly more men in the US were obese (63% vs. 26%, p < 0.001) compared to Canada. Intrauterine insemination use among female partners was more common in Canada (13% vs. 7%, p < 0.001) while in vitro fertilization was less common (6% vs. 9%, p = 0.01) when compared to the US. Finasteride (3% vs. 0%) and testosterone usage (4% vs. 1) were more common among US men versus Canadians, respectively. In conclusion, geographical differences exist between North American males undergoing fertility evaluation. American men are older and more obese and have a longer average duration of infertility. Potentially reversible factors contributing to male infertility are more prevalent in the US. [ABSTRACT FROM AUTHOR]

Background: Hematospermia is an alarming symptom and can cause significant patient distress, but work‐up is often negative. Objective: To characterize the clinical evaluation of hematospermia and its association with the diagnosis of urologic malignancy. Materials and methods: Using MarketScan insurance claims database, we identified adult males 18–64 years old diagnosed with hematospermia from 2010 to 2018. Benign hematospermia was defined as the absence of hematuria and elevated prostate‐specific antigen. Patients with urologic cancer prior to diagnosis of hematospermia were excluded. We identified those who were diagnosed with a urologic malignancy. Results: The annual average incidence rate of hematospermia was 56.6 per 100,000 (95% confidence interval 55.4–57.8 per 100,000) in 2010 and increased to 73.6 per 100,000 (95% confidence interval 71.7–75.4 per 100,000) in 2018. A total of 56,157 patients presented with benign hematospermia. Most (57.5%) underwent at least one test, with the most common being urinalysis (51.7%), followed by prostate‐specific antigen testing (11.9%). All other tests were performed in less than 3% of patients. Forty‐seven patients were diagnosed with a urologic cancer, including 28 with prostate cancer (0.05%), nine with testicular cancer (0.016%), six with prostate carcinoma in situ (0.01%), and four with bladder cancer (0.007%). Stratified by age, there was only one cancer diagnosis (testicular) in 15,106 patients under 40 years (0.01%) and 46 cancer diagnoses in 40,611 patients 40 years old or above (0.11%). The median age of patients diagnosed with cancer was 56 years (interquartile range 52–61). Discussion and conclusion: A small minority of patients with benign hematospermia were later diagnosed with urologic cancer in a large nationally representative sample. After excluding hematuria with urinalysis, physicians should conservatively manage and reassure patients with hematospermia, especially those under 40 years of age. [ABSTRACT FROM AUTHOR]

The following discussion is intended to analyze the benefits and costs to society from the implementation of the Act. No criticism of the purpose of the Act is intended or implied. The analysis does not cover the changes to the Act embodied in the Equal Credit Opportunity Act Amendments of 1976 (Public Law 94-239), since the Board published final regulations implementing that Act on December 29, 1976, and they did not become effective until March 23, 1977 [5] and [17]. [ABSTRACT FROM AUTHOR]

Once unimaginable, fertility management is now a nationally established part of cancer care in institutions, from academic centers to community hospitals to private practices. Over the last two decades, advances in medicine and reproductive science have made it possible for men, women and children to be connected with an oncofertility specialist or offered fertility preservation soon after a cancer diagnosis. The Oncofertility Consortium's National Physicians Cooperative is a large-scale effort to engage physicians across disciplines - oncology, urology, obstetrics and gynecology, reproductive endocrinology, and behavioral health - in clinical and research activities to enable significant progress in providing fertility preservation options to children and adults. Here, we review the structure and function of the National Physicians Cooperative and identify next steps. [ABSTRACT FROM AUTHOR]

Abstract Over the three decades leading up to the crisis of 2008, inequality dramatically increased in the United States and Great Britain. What stands out, but is seldom noted, is that this occurred within democracies where the relative losers-the overwhelming majority-could in principle have used the political system to block or reverse rising inequality. Why did they not do so? A glance at history reveals that peoples have only very infrequently contested inequality because they were led to believe that their inferior status in terms of income, wealth, and privilege was just, that it was not really so bad, or that it was necessary for their future well-being. Ideological systems legitimated a status quo of inequality, or in more modern times even increasing inequality. This article surveys the manner in which inequality has been historically legitimated, first predominantly by religion, then predominately by economic thought. Attention is then focused on the manner in which contemporary economic science and its popular interpretations in the media have served to legitimate inequality in the U.S. since the mid-1970s. The article concludes with a reflection on the unique conditions that enable the legitimation of inequality to be delegitimated. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of income, education, and race on the use and outcomes of infertility care.Design: Prospective cohort.Setting: Eight community and academic infertility practices.Patient(s): Three hundred ninety-one women presenting for an infertility evaluation.Intervention(s): Face-to-face and telephone interviews and questionnaires.Main Outcome Measure(s): Use of infertility services and odds of pregnancy. Linear and logistic regression used to assess relationship between racial and socioeconomic characteristics, use of infertility services, and infertility outcomes.Result(s): After adjustment for age and demographic and fertility characteristics, college-educated couples (β = $5,786) and households earning $100,000-$150,000 (β = $6,465) and ≥$150,000 (β = $8,602) spent significantly more on infertility care than their non-college-educated, lower-income counterparts. Higher income and college-educated couples were much more likely to use more cycles of higher-intensity fertility treatment. The increased cost of infertility care was primarily explained by these differences in number and type of infertility treatment. Even after adjustment for these factors and total amount spent on fertility care, having a college degree was associated with persistently higher odds of achieving a pregnancy (OR = 1.9).Conclusion(s): Education and household income were independently associated with the amount of money spent on fertility care. This relationship was primarily explained by types and intensity of infertility treatments used. Having at least a college degree was independently associated with improved odds of pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship between number of fertility treatment cycles and pregnancy rates.Design: Prospective cohort study.Setting: Eight community and academic infertility practices.Patient(s): Four hundred eight (408) couples presenting for an infertility evaluation.Intervention(s): Face-to-face and telephone interviews and questionnaires.Main Outcome Measure(s): Incidence of pregnancy. Cox regression analysis compared the efficacy of cycle-based fertility treatments with no cycle-based fertility treatment after multivariable adjustment.Result(s): Couples using one to two medications-only cycles had a significantly higher pregnancy rate (hazard ratio [HR] 4.7 [95% confidence interval 1.3-16.6]), a benefit that did not persist after three or more cycles (HR 0.6 [0.1-3.2]). Couples using IUI for one (HR 2.9 [1.4-5.8]), two (HR 2.0 [0.9-4.5]), and three cycles (HR 4.5 [1.8-10.9]) were more likely to achieve a pregnancy. No additional benefit was seen for couples using four or more IUI cycles (HR 1.0 [0.4-2.6]). In vitro fertilization was associated with significant benefit for couples using one (HR 2.8 [1.5-5.2]) and two cycles (HR 2.2 [1.2-4.1]). Couples using three or more IVF cycles had a non-statistically significant higher likelihood of pregnancy (HR 1.3 [0.7-2.4]).Conclusion(s): Cycle-based fertility treatments may offer a point of diminishing returns for infertile couples: two cycles of medications only, three cycles of IUI, and two cycles of IVF. [ABSTRACT FROM AUTHOR]

BACKGROUND: Investigators have postulated that family size may be influenced by biologic fertility potential in addition to sociodemographic factors. The aim of the current study is to determine if a diagnosis of infertility is associated with family size in the USA. METHODS: We analyzed data from the male and female samples of the 2002 National Survey of Family Growth using multivariable logistic regression models to determine the relationship between infertility and family size while adjusting for sociodemographic and reproductive characteristics. RESULTS: In the survey, 4409 women and 1739 men met the inclusion criteria, of whom 10.2% and 9.7%, respectively, were classified as infertile, on the basis of having sought reproductive assistance. Infertile females had a 34% reduced odds of having an additional child compared with women who did not seek reproductive assistance. For each additional 6 months it took a woman to conceive her first child, the odds of having a larger family fell by 9% and the odds of having a second child were reduced by 11%. A diagnosis of male infertility reduced the odds of having a larger family more than a diagnosis of female infertility. CONCLUSIONS: A diagnosis of infertility, especially male factor, is associated with reduced odds of having a larger family, implicating a biologic role in the determination of family size in the USA. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of complementary and alternative medicine (CAM) use among couples seeking fertility care and to identify the predictors of CAM use in this population.Design: Prospective cohort study.Setting: Eight community and academic infertility practices.Patient(s): A total of 428 couples presenting for an infertility evaluation.Intervention(s): Interviews and questionnaires.Main Outcome Measure(s): Prevalence of complementary and alternative medicine therapy.Result(s): After 18 months of observation, 29% of the couples had utilized a CAM modality for treatment of infertility; 22% had tried acupuncture, 17% herbal therapy, 5% a form of body work, and 1% meditation. An annual household income of > or = $200,000 (odds ratio 2.8, relative to couples earning <$100,000), not achieving a pregnancy (odds ratio 2.3), and a positive attitude toward CAM use at baseline were independently associated with CAM use.Conclusion(s): A substantial minority of infertile couples use CAM treatments. CAM was chosen most commonly by wealthier couples, those not achieving a pregnancy, and those with a baseline belief in the effectiveness of CAM treatments. [ABSTRACT FROM AUTHOR]

The article discusses the significance of information technology (IT) in addressing workforce challenges in the U.S. It mentions that IT not only helps create, and support knowledge management and training functions, but enables companies to achieve cost efficiencies during economic crisis. It states that online social networking sites also allow individuals and job seekers to look for job openings.

The article presents an economic outlook for the U.S for 2009-2010. Total construction spending in the country only fell by 5.5% to $1.14 trillion in 2008 but residential construction spending decreased by 27.7% to $766.9 billion. Several economic stimulus packages have been introduced, including the $168 billion from the Economic Stimulus Act of 2008, which resulted in real gross domestic product (GDP) growth rate of 2.6% in the second quarter of 2008, and the American Recovery and Reinvestment Plan of 2009. However, the U.S. Federal Reserve is expected to intervene if recovery would not be observed in banks, insurance companies, pension funds and other traditional lenders.

There is no evidence of a housing "bubble" in the United States and housing demand should stay strong for years to come. Three major factors lead to this conclusion. First, the 77 million baby boomers are approaching the peak home ownership ages of 65-75 (over 83.0 percent versus a national average in 2004 of 69.0 percent). Second, immigrants, a growing share of the U.S. population, tend to buy houses ten years later than people born in the United States of the same income group and family size. Third, mortgage rates are not likely to go high enough (8.0 percent or more for 30-year fixed rate mortgages) to put a crimp in demand. Despite some areas of concern, overall homeowners' equity is at record levels above $9 trillion. Delinquencies are still less than one percent of mortgages outstanding. [ABSTRACT FROM AUTHOR]

This article focuses on Ben Siegel, father of Las Vegas and the modern casino-hotel. It was said that The Fabulous Flamingo defied all laws of gaming science. Its story was considered the story of modern Las Vegas, and by extension, the modern casino-hotel industry in the U.S. Under the antiseptic corporate flag of Hilton International, the hotel is very much in the mainstream of the gambling world and its reflection of the American Dream. In 1942, when Ben Siegel made his first appearance in Las Vegas, the city was little more than a sleepy western town. There had been legalized gambling in Las Vegas since 1931, fueled in part by workers from Hoover Dam and later by the servicemen and defense personnel stationed in southern Nevada during the war; but the mecca for the West's high-rollers was Reno, more than 400 miles to the northwest. Siegel had come to finalize arrangements for the casinos with racebooks to use Trans-America Wire Service, which he controlled, to post their race results. His share of the action amounted to approximately $25,000 per month, and ultimately he and his advance man Moe Sedway obtained interest in several Las Vegas gambling halls, including the Golden Nugget and the Frontier Club. However, at that time, Siegel preferred the genteel life of southern California, managing various businesses while partying with movie stars and visiting nightclubs on the Sunset Strip.

The author responds to the comment made in regard to his article on race and human capital. According to the author, to arrive at a tenable interpretation of Black history, it is important to resolve the conflict between my measure, namely, retrospective years of schooling completed, and Robert Margo's measure, that is, prospective accumulation across ages of cohort-specific attendance rates. Three basic points that are made here are: reporting biases in census school attendance data distort the true school-accomplishment profiles of cohorts; school attendance rates are inherently biased measures of racial differences in school completion; and the reasons for Blacks' less rapid schooling advances are largely independent of whether southern Black schools changed from an upgraded to a graded system during these years. Black-White education differences were stable during the retrogression era, in sharp contrast to the substantial education advances that southern Blacks would subsequently enjoy. If one consequence of the deteriorating quality was increasing Black grade retention, one must find rising relative Black attendance coexisting with stable race differences in grade completed.

Presents an address by the president of the National Association of Business Economics which considers the quality of education in the United States. Suggestions on how NABE members can get involved.

We studied a prospective cohort of 434 couples in Northern California and found that 13% did not pursue any form of infertility treatment after their initial consultation. Although age, education, and financial concerns remain important for patients in choosing whether to pursue infertility treatment, depressive symptoms may also be a barrier to achieving reproductive goals. [ABSTRACT FROM AUTHOR]

Introduction. Individuals who engage in regular sexual intercourse are more likely to report good overall quality of life. Studies of sexuality in adolescents have focused on high-risk behaviors whereas similar studies in older adults have focused on sexual dysfunction. Given a paucity of data on the sexual behaviors of young adults and the possibility of important relationships between sexuality and overall health, we sought to determine factors that influence the frequency of intercourse in adult men and women in the United States. Aim. To identify factors related to coital frequency in young and middle-aged adults. Methods. We analyzed data from the male and female sample of the 2002 National Survey of Family Growth to examine frequency of sexual intercourse among Americans aged 25–45 years (men: N = 2,469; women: N = 5,120). Main Outcome Measures. Multivariable negative binomial regression modeling was used to test for independent associations between the frequency of sexual intercourse and demographic, socioeconomic, and anthropometric variables. Results. In this study, men and women between the ages of 25 and 45 have sex a mean 5.7 and 6.4 times per month, respectively. Being married significantly increased coital frequency for women but has no effect on male coital frequency. Increased height, less than high school education, and younger age were predictive of increased sexual frequency in men. Pregnancy was associated with significantly lower coital frequency for both men and women. No association was shown between self-reported health status and coital frequency on multivariable analysis. Conclusions. Among young male adults, coital frequency is associated with specific socioeconomic, demographic, and anthropomorphic characteristics. Sexual frequency in women does not appear to be influenced by such factors. Self-reported health is not predictive of sexual activity in this age group. Eisenberg M, Shindel AW, Smith JF, Breyer BN, and Lipshultz LI. Socioeconomic, anthropomorphic, and demographic predictors of adult sexual activity in the United States: Data from the national survey of family growth. J Sex Med 2010;7:50–58. [ABSTRACT FROM AUTHOR]

Introduction. Little is known about young and middle aged adults who have never engaged in sexual intercourse. Individuals who have not engaged in sexual activity may theoretically have diminished overall quality of life, as recent evidence suggests that sexual activity may be related to overall health status in adults. Aim. We sought to identify factors related to sexual abstinence in young and middle-aged adults. Methods. We analyzed data from the male and female sample of the 2002 National Survey of Family Growth to examine sexual abstinence among unmarried participants aged 25–45 (men: N = 2,469; women: N = 5,120). Main Outcome Measures. Multivariable logistic regression modeling was used to test for independent associations between demographic, medical, and anthropometric variables and abstinence while adjusting for confounding and mediating variables. Results. A total of 122 (13.9%) men aged 25–45 reported never having had sex, representing approximately 1.1 million American men in this age cohort. Among female participants, a total of 104 (8.9%) women aged 25–45 reported never having sex, representing approximately 800,000 American women in this age cohort. Both men and women who reported that they attend religious services one or more times per week were more likely to be sexually abstinent, independent of their specific religious beliefs. Virgin status was also significantly associated with drinking alcohol within the past year. While a college degree in women predicted virginity, education was not associated with virginity in men. Men showed lower rates of sexual abstinence if they reported having spent time in prison or serving in the military. Conclusions. Amongst young adults, sexual abstinence does not appear to be mediated by health status, anthropometric measures, or age. Attending religious services and avoidance of alcohol consumption are associated with virginity in adults. Other factors associated with abstinence differ between genders and merit further study. Eisenberg ML, Shindel AW, Smith JF, Lue TF, and Walsh TJ. Who is the 40 year old virgin and where did he/she come from? Data from the National Survey of Family Growth. J Sex Med 2009;6:2154–2161. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between vitamin D levels in the male partner and fertility outcomes in couples with mild male factor infertility.Design: Secondary analysis of a randomized, controlled trial.Setting: Nine fertility centers in the United States.Patient(s): Men (n = 154) with sperm concentration between 5 and 15 million/mL, motility ≤40%, or normal morphology ≤4% were eligible. Female partners were ovulatory, ≤40 years old, and had documented tubal patency.Intervention(s): Men provided semen and blood at baseline for semen analysis and 25-hydroxyvitamin D (25(OH)D) levels. They were randomly assigned to receive a vitamin formulation including vitamin D 2,000 IU daily or placebo for up to 6 months. Couples attempted to conceive naturally during the first 3 months and with clomiphene citrate with intrauterine insemination of the female partner in months 4 through 6.Main Outcome Measure(s): Primary: sperm concentration, motility, morphology, and DNA fragmentation at baseline. Secondary: cumulative pregnancy, miscarriage, and live birth rates.Result(s): Semen parameters and sperm DNA fragmentation were not statistically significantly different between men with vitamin D deficiency and men with 25(OH)D levels ≥20 ng/mL. In addition, clinical pregnancy and live birth rates were similar. Male 25(OH)D level <20 ng/mL was associated with a higher rate of pregnancy loss (adjusted odds ratio 9.0; 95% confidence interval 1.3 to 61.3).Conclusion(s): Vitamin D deficiency in the male partner did not significantly impact semen parameters or treatment outcomes. Further study is warranted to better characterize the rate of miscarriage in couples with male vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Objective To estimate the prevalence of male factor infertility diagnosis within the context of assisted reproductive technology (ART) clinics and its geographic and temporal distribution from 1999-2010. Design Population study based on patients presenting for care at ART centers. Setting Clinics providing ART services. Patient(s) All male patients seeking infertility care at ART clinics. Intervention(s) Data were obtained from the Centers for Disease Control and Prevention, analyzed, geocoded, and mapped. Main Outcome Measure(s) Prevalence of male factor infertility diagnosis in a couple seeking infertility care. Result(s) Between 1999 and 2010, 1,057,402 cycles of ART using nonfrozen, nondonor eggs were performed, increasing from 62,809 cycles in 1999 to 99,289 cycles in 2010. Nationwide in ART clinics, the period prevalence of isolated male factor infertility was 17.1% and the prevalence of overall male factor infertility diagnoses was 34.6%. The highest prevalence was reported in New Mexico (56.4%) and lowest in Mississippi (24.2%). Conclusion(s) The prevalence of male factor infertility diagnosis varies significantly by time and space within the United States, whereas its overall prevalence has remained remarkably stable. This study provides the spatial analytic framework for future research to explore factors associated with male factor infertility. [ABSTRACT FROM AUTHOR]

Objective: To determine whether antioxidants improve male fertility, as measured by semen parameters and DNA fragmentation at 3 months and pregnancy resulting in live birth after up to 6 months of treatment, among couples with male factor infertility.Design: Multicenter, double-blind, randomized, placebo-controlled trial with an internal pilot study.Setting: Nine fertility centers in the United States from December 2015 to December 2018.Patient(s): Men (N = 174) with sperm concentration ≤15 million/mL, motility ≤40%, normal morphology ≤4%, or DNA fragmentation >25%, and female partners who were ovulatory, ≤40 years old, and had documented tubal patency.Intervention(s): Males randomly assigned to receive an antioxidant formulation (n = 85) containing 500 mg of vitamin C, 400 mg of vitamin E, 0.20 mg of selenium, 1,000 mg of l-carnitine, 20 mg of zinc, 1,000 μg of folic acid, 10 mg of lycopene daily, or placebo (n = 86). Treatment lasted for a minimum of 3 months and maximum of 6 months, and couples attempted to conceive naturally during the first 3 months and with clomiphene citrate with intrauterine insemination of the female partner in months 4 through 6.Main Outcome Measure(s): Primary outcome was live birth; secondary outcomes included pregnancy within 6 months of treatment. For the internal pilot, the primary outcomes were semen parameters and sperm DNA fragmentation index after 3 months of treatment.Result(s): In the Males, Antioxidants, and Infertility (MOXI) study, after 3 months of treatment, the change in sperm concentration differed between the antioxidant group (median -4.0 [interquartile range-12.0, 5.7] million/mL) and placebo group (+2.4 [-9.0, 15.5] million/mL). However, there were no statistically significant differences between the two groups for changes in sperm morphology, motility, or DNA fragmentation. Among the 66 oligospermic men at randomization, sperm concentration did not differ at 3 months between the antioxidant and control groups: 8.5 (4.8, 15.0) million/mL versus 15.0 (6.0, 24.0) million/mL. Of the 75 asthenospermic men, motility did not differ at 3 months: 34% ± 16.3% versus 36.4% ± 15.8%. Among the 44 men with high DNA fragmentation, DNA fragmentation did not differ at 3 months: 29.5% (21.6%, 36.5%) versus 28.0% (20.6%, 36.4%). In the entire cohort, cumulative live birth did not differ at 6 months between the antioxidant and placebo groups: 15% versus 24%.Conclusion(s): Antioxidants do not improve semen parameters or DNA integrity among men with male factor infertility. Although limited by sample size, this study suggests that antioxidant treatment of the male partner does not improve in vivo pregnancy or live-birth rates.Clinical Trial Registration Number: NCT02421887. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcomes of assisted reproductive technology (ART) cycles for male factor infertility, and method of sperm collection., Design: Historic cohort study., Setting: Clinic-based data., Patients: Cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System database for 2004 to 2008 were limited to three groups: non-intracytoplasmic sperm injection (ICSI) and ICSI cycles for tubal ligation only; non-ICSI and ICSI cycles for male factor infertility only; and all cycles (regardless of infertility diagnosis) using ICSI only., Intervention(s) and Main Outcome Measure(s): Multivariate logistic regression was used to model the adjusted odds ratio (AOR) of clinical intrauterine gestation (CIG) and live birth (LB) rates for tubal ligation versus male factor infertility only; ICSI versus non-ICSI for male factor infertility only; and ICSI outcomes based on method of sperm collection., Result(s): Models for male factor infertility only versus tubal ligation only ICSI cycles had lower CIG (AOR 0.92) but not LB (AOR 0.87). No difference was seen for non-ICSI cycles. Within male factor infertility only cycles, ICSI had a worse outcome than non-ICSI for CIG (AOR 0.93) but not for LB (AOR 0.94). For all ICSI cycles with no male factor infertility and ejaculated sperm as the reference group, models showed better rates of CIG with male factor infertility ejaculated sperm (AOR 1.07) and with male factor infertility aspirated sperm (AOR 1.09). The LB rate was higher with male factor infertility ejaculated sperm only (AOR 1.04)., Conclusion(s): The ICSI and sperm source influence CIG and LB rates in male factor infertility cases., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

HIV infection is associated with sexual dysfunction. Using validated instruments, we investigated the relationship between HIV/AIDS and sexual function in a contemporary cohort of men who have sex with men (MSM). An anonymous Internet-based survey was disseminated to MSM via organizations and social networking sites that cater to this population. Information on ethnodemographic variables, health status (including HIV status, disease stage, and other health conditions), and sexual behavior was collected. Men were categorized as HIV-negative, HIV-positive/AIDS-negative, or HIV-positive /AIDS-positive. A modified validated version of the International Index of Erectile Function (IIEF) for use in MSM and the Premature Ejaculation Diagnostic Tool (PEDT) were used to stratify risk of sexual dysfunction. The study cohort included 1361 men (236 of whom were HIV-positive) who provided complete data on HIV status, IIEF, and PEDT. There was a significant trend toward greater prevalence of erectile dysfunction (ED) in men with progressive HIV infection 40-59 years of age relative to age matched HIV-negative men (p=0.02). In a logistic regression model controlling for other variables, HIV infection without AIDS was not associated with greater odds of ED; however, HIV infection with AIDS was associated with greater odds of ED (p=0.006). In a separate logistic regression model, HIV infection with or without AIDS was not significantly associated with greater odds of premature ejaculation (p>0.05). Use of phosphodiesterase 5 (PDE5) inhibitor drugs was much more common in HIV-infected men. HIV infection is a risk factor for poorer sexual function primarily due to higher risk of erectile dysfunction in men with AIDS.

Newborn male circumcision has been practiced for millennia for a variety of medical, social, religious, and cultural reasons. Indications for routine circumcision remain controversial, with proponents and dissidents arguing their sides vigorously. Popular in the United States, it has persisted in the scope of practice of obstetrics and gynecology, a field specializing in the opposite gender. To excel in women's reproductive health, we should no longer passively accept or actively maintain this procedure in our specialty. Steps are suggested to remove the residual and improper inclusion of circumcision from the scope of practice of obstetrics and gynecology., (© Thieme Medical Publishers.)

Infertility is generally defined as the inability to conceive a pregnancy or the failure to do so within a reasonable period (typically 12 months). Approximately 85% of couples conceive a first pregnancy within 12 months. The prevalence of infertility has increased over the past 10 years, with approximately 10 million affected couples in the United States. Roughly 40% to 50% of infertility is either due to, or is contributed by, a male factor. Given how common the condition is, men and their partners are understandably concerned and interested in identifying and eliminating risk factors for male infertility. This article reviews the available literature on various aspects of male infertility related to athletic pursuits. These include the effects of exercise on semen parameters, hormonal axes, and testicular health. Due to the prevalence and particular relevance of anabolic steroid use by athletes and the impact of steroid use on fertility, this topic is also reviewed.

Purpose: To determine factors associated with students' comfort in addressing patients' sexuality in the clinical context., Method: The authors invited students enrolled in MD-degree-granting and osteopathic medical schools in the United States and Canada to participate in an anonymous Internet survey between February and July 2008. The survey assessed ethnodemographic factors and sexual history. Respondents also completed the Center for Epidemiologic Studies Depression Scale. Male respondents completed the International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool. Female respondents completed the Female Sexual Function Index and the Index of Sex Life. The authors used descriptive statistics, ANOVA, and multivariable logistic regression to analyze responses., Results: The authors' analyses included 2,261 completed survey responses: 910 from men, 1,343 from women, and 8 from individuals who self-identified as "other" gendered. Over 53% of respondents (n = 1,206) stated that they felt they had not received sufficient training in medical school to address sexual concerns clinically. Despite this, 81% of students (n = 1,827) reported feeling comfortable dealing with their patients' sexuality issues. Students with limited sexual experience, students at risk for sexual problems, and students who felt that they had not been trained adequately were less likely to report being comfortable talking to patients about sexual health issues., Conclusions: Perception of inadequate sexuality training in medical school and personal issues pertaining to sex may be associated with students' difficulty in addressing patients' sexuality. Adequate training is preeminently associated with feeling comfortable addressing patients' sexuality and should be a priority for medical education.

Objectives: To explore whether health care, socioeconomic, or personal characteristics account for disparities observed in the utilization of vasectomy. More than 500,000 vasectomies are performed annually in the United States. The safety and efficacy of vasectomy make it a good family planning option, yet the factors related to use of male surgical sterilization are not well understood. In this analysis, we examined differences in vasectomy rates according to factors such as race and socioeconomic status., Methods: We analyzed data from the male sample of the 2002 National Survey of Family Growth to examine the use of vasectomy among the sample of men aged 30-45 (n = 2161). Demographic, socioeconomic, and reproductive characteristics were analyzed to assess associations with vasectomy., Results: About 11.4% of men aged 30-45 years reported having a vasectomy, representing approximately 3.6 million American men. Although 14.1% of white men had a vasectomy, only 3.7% of black and 4.5% of Hispanic men reported undergoing vasectomy. On multivariate analysis, a significant difference in the odds of vasectomy by race/ethnicity remained, with black (odds ratio = 0.20, 0.09-0.45) and Hispanic men (odds ratio = 0.41, 0.18-0.95) having a significantly lower rate of vasectomy independent of demographic, partner, and socioeconomic factors. Having ever been married, fathering 2 or more children, older age, and higher income were the factors associated with vasectomy., Conclusions: After accounting for reproductive history, partner, and demographic characteristics, black and Hispanic men were less likely to rely on vasectomy for contraception. Further research is needed to identify the reasons for these race/ethnic differences and to identify factors that impede minority men's reliance on this means of fertility control.