{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:09:06Z","timestamp":1764785346045,"version":"3.37.0"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T00:00:00Z","timestamp":1712534400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Andrology"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Phosphodiesterase 5 inhibitors (PDE5is) represent a first\u2010line pharmacological therapy for erectile dysfunction (ED). Men could obtain PDE5is for recreational purposes without any proper medical prescription.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We aimed to analyze clinical characteristics of patients who already used any PDE5i for ED without previous formal medical prescription.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Data from 2012 heterosexual, sexually active men seeking first medical help for ED at our outpatient clinic between 2005 and 2022 were analyzed. All patients were assessed with a comprehensive sexual and medical history and completed the International Index of Erectile Function (IIEF) at baseline. Comorbidities were scored with the Charlson comorbidity index (CCI). Thereof, according to exposure to any PDE5i before their first visit, patients were subdivided into: PDE5i\u2010na\u00efve and non\u2010PDE5i\u2010na\u00efve patients. Descriptive statistics tested the sociodemographic and clinical characteristics of both groups. A logistic regression model predicted the likelihood of being PDE5i\u2010na\u00efve at the baseline. Linear regression analysis (LRA) estimated the likelihood of being PDE5i\u2010na\u00efve versus non\u2010PDE5i\u2010na\u00efve over the analyzed timeframe. Lastly, local polynomial regression models graphically explored the likelihood of being PDE5i\u2010na\u00efve at the first clinical assessment over the analyzed timeframe, and the sensitivity analyses tested the probability of being PDE5i\u2010na\u00efve at baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 1,491 (70.9%) patients were PDE5i\u2010na\u00efve and 611 (29.1%) were non\u2010PDE5i\u2010na\u00efve at the first assessment. PDE5is\u2010na\u00efve patients were younger, with a lower prevalence of CCI \u2265 1 and of normal erectile function (EF) than non\u2010PDE5i\u2010na\u00efve men (all <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05). Multivariable logistic regression found that patients with lower BMI (OR: 0.99), higher IIEF\u2010EF scores (OR: 1.02), lower rates of severe ED (OR: 0.94), and who had been assessed earlier throughout the study timeframe (OR: 1.27) were less likely to be PDE5i\u2010na\u00efve at baseline. Univariate LRA revealed that younger patients (Coeff: \u22120.02), with lower CCI (Coeff: \u22120.29) and higher alcohol intake per week (Coeff: 0.52) were more likely to be PDE5i\u2010na\u00efve over the analyzed timeframe. Moreover, for the same IIEF\u2010EF score, patients with higher CCI had lower probability of being PDE5i\u2010na\u00efve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Self\u2010prescription of PDE5is is an attitude presents in the general population, despite this phenomenon has decreased overtime. Current data outline the importance to keep promoting educational campaigns to promote PDE5is as effective and safe medicinal products, while avoiding their improper use.<\/jats:p><\/jats:sec>","DOI":"10.1111\/andr.13641","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T15:53:21Z","timestamp":1712591601000},"page":"323-330","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["PDE5is\u2010na\u00efve versus non\u2010na\u00efve patients at first investigation for erectile dysfunction\u2014findings from a long\u2010term, real\u2010life cross\u2010sectional study"],"prefix":"10.1111","volume":"13","author":[{"given":"Simone","family":"Cilio","sequence":"first","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"},{"name":"Department of Neurosciences Reproductive Sciences and Odontostomatology, Urology Unit University of Naples \u201cFederico II\u201d  Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2347-9504","authenticated-orcid":false,"given":"Paolo","family":"Capogrosso","sequence":"additional","affiliation":[{"name":"Department of Urology Circolo &amp; Fondazione Macchi Hospital\u2010ASST Sette Laghi  Varese Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Pozzi","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"},{"name":"Division of Experimental Oncology\/Unit of Urology Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2165-659X","authenticated-orcid":false,"given":"Federico","family":"Belladelli","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"},{"name":"Division of Experimental Oncology\/Unit of Urology Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Corsini","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"},{"name":"Division of Experimental Oncology\/Unit of Urology Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimiliano","family":"Raffo","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Candela","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology URI, IRCCS Ospedale San Raffaele  Milan 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