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Men who did not use at least a drug for sexual health in the past 3 months, had cancer or spinal cord injuries, and\/or underwent non\u2013nerve-sparing radical prostatectomy were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The 15-item International Index of Erectile Function (IIEF-15) with study-specific, self-constructed questions was used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 940 subjects (age\u00a0= 46.2 \u00b1 13.4 years) were considered. Subjects (n\u00a0= 778) using on-demand phosphodiesterase type 5 inhibitors (PDE5is) were designated \u201cperformers\u201d (60%) without a formal ED diagnosis or \u201cpatients\u201d with a medical diagnosis. Patients were older than performers, with more self-reported comorbidities; patients used a higher PDE5i dosage and purchased it from official pharmacies more often than performers did. Of avanafil users (n\u00a0= 39), no differences in total IIEF or subdomain scores were observed after adjusting for confounders. However, avanafil users less often declared its use without an ED diagnosis and a physician prescription. Overall, the latter condition was associated with higher PDE5i-related satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The survey shows 2 different attitudes toward ED and PDE5i use: for recreational use and without a medical prescription or with a formal diagnosis and medical prescription. Avanafil, a 2nd-generation PDE5i with a good balance between efficacy and tolerability profile, is more frequently prescribed by doctors than self-prescribed compared with other PDE5is. Because the major challenge is to decrease the high dropout of 1st-generation PDE5is, further studies will be needed to clarify this topic.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.esxm.2017.10.003","type":"journal-article","created":{"date-parts":[[2017,12,21]],"date-time":"2017-12-21T14:12:12Z","timestamp":1513865532000},"page":"15-23","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":20,"title":["EDEUS, a Real-Life Study on the Users of Phosphodiesterase Type 5 Inhibitors: Prevalence, Perceptions, and Health Care-Seeking Behavior Among European Men With a Focus on 2nd-Generation Avanafil"],"prefix":"10.1093","volume":"6","author":[{"given":"Giovanni","family":"Corona","sequence":"first","affiliation":[{"name":"Endocrinology Unit \u00a0 , Azienda-Usl Bologna, Bologna , Italy"},{"name":"Medical Department, Maggiore-Bellaria Hospital \u00a0 , Azienda-Usl Bologna, Bologna , Italy"},{"name":"Sexual Medicine and Andrology Unit \u00a0 , Florence , Italy"},{"name":"Department of Experimental, Clinical and Biomedical Sciences, University of Florence \u00a0 , Florence , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Maggi","sequence":"additional","affiliation":[{"name":"Sexual Medicine and Andrology Unit \u00a0 , Florence , Italy"},{"name":"Department of Experimental, Clinical and Biomedical Sciences, University of Florence \u00a0 , Florence , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuele A.","family":"Jannini","sequence":"additional","affiliation":[{"name":"Chair of Endocrinology and Sexual Medicine (ENDOSEX) \u00a0 \u00a0 , Rome , Italy"},{"name":"Department of Systems Medicine \u00a0 \u00a0 , Rome , Italy"},{"name":"University of Rome Tor Vergata \u00a0 \u00a0 , Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,12,21]]},"reference":[{"key":"2023012006394399300_bib1","first-page":"144","article-title":"Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015","volume":"13","author":"McCabe","year":"2016","journal-title":"J\u00a0Sex Med"},{"key":"2023012006394399300_bib2","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1161\/CIRCOUTCOMES.112.966903","article-title":"Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies","volume":"6","author":"Vlachopoulos","year":"2013","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2023012006394399300_bib3","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.beem.2013.05.007","article-title":"Sexual function of the ageing male","volume":"27","author":"Corona","year":"2013","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"2023012006394399300_bib4","first-page":"173","article-title":"Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors","volume":"11","author":"Rastrelli","year":"2014","journal-title":"J\u00a0Sex Med"},{"key":"2023012006394399300_bib5","first-page":"1347","article-title":"High triglycerides predicts arteriogenic erectile dysfunction and major adverse cardiovascular events in subjects with sexual dysfunction","volume":"13","author":"Corona","year":"2016","journal-title":"J\u00a0Sex Med"},{"key":"2023012006394399300_bib6","doi-asserted-by":"crossref","first-page":"581","DOI":"10.4103\/1008-682X.126386","article-title":"Erectile dysfunction and central obesity: an Italian perspective","volume":"16","author":"Corona","year":"2014","journal-title":"Asian J Androl"},{"key":"2023012006394399300_bib7","first-page":"1074","article-title":"Risk factors associated with primary and secondary reduced libido in male patients with sexual dysfunction","volume":"10","author":"Corona","year":"2013","journal-title":"J\u00a0Sex Med"},{"key":"2023012006394399300_bib8","first-page":"2017","article-title":"SIEDY scale 3, a new instrument to detect psychological component in subjects with erectile dysfunction","volume":"9","author":"Corona","year":"2012","journal-title":"J\u00a0Sex Med"},{"key":"2023012006394399300_bib9","first-page":"2591","article-title":"Impairment of couple relationship in male patients with sexual dysfunction is associated with overt hypogonadism","volume":"6","author":"Corona","year":"2009","journal-title":"J\u00a0Sex Med"},{"key":"2023012006394399300_bib10","first-page":"669","article-title":"Bidirectional relationship between depression and erectile dysfunction","volume":"177","author":"Shiri","year":"2007","journal-title":"J\u00a0Urol"},{"key":"2023012006394399300_bib11","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1007\/BF03347477","article-title":"Are subjects with erectile dysfunction aware of their condition? 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