{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:13Z","timestamp":1787028613947,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Penile echo-color Doppler ultrasound (PCDU) is the gold standard for the diagnosis of arterial erectile dysfunction (ED). Its reliability in patients with anxiety was questioned, due to false-positive results. Aim: To assess the penile hemodynamic response to intracavernous injection (ICI) of alprostadil in patients with anxiety-related ED. Methods: Patients with non-organic ED and a 5-item International Index of Erectile Function (IIEF-5) score ranging between 5 and 7 were enrolled. They were asked to compile the 7-item Generalized Anxiety Disorder (GAD-7) questionnaire to assess the degree of anxiety and were divided according to the GAD-7 score in Group 1 with minimal level of anxiety (n = 20), Group 2 with mild anxiety (n = 20), Group 3 with moderate anxiety (n = 20), and Group 4 with severe anxiety (n = 20). Peak systolic velocity (PSV) and the end-diastolic velocity (EDV) were sampled in all patients, through PCDU in the flaccid state, and 5, 10, 15, and 20 min after ICI of alprostadil at the standard dose of 10 \u03bcg. Results: In penile flaccidity, the patients showed a mean PSV of 8.0 \u00b1 4.0 cm\/s. The degree of anxiety was found to significantly influence both PSV and EDV at all assessed time-points. Particularly, it was negatively associated with the PSV at time 5 (r = \u22120.9, p &lt; 0.01), 10 (r = \u22120.9, p &lt; 0.01), 15 (r = \u22120.9, p &lt; 0.01), and 20 (r = \u22120.7, p &lt; 0.01) minutes, and positively with the EDV at time 5 (r = 0.7, p &lt; 0.01), 10 (r = 0.6, p &lt; 0.01), 15 (r = 0.5, p &lt; 0.01), and 20 (r = 0.3, p &lt; 0.01) minutes. Although all patients showed a mean dynamic PSV &gt; 25 cm\/s (which excluded an arterial ED according to the current guidelines), a peculiar hemodynamic pattern was found in patients with severe anxiety. In these patients, normal PSV values were reached only after 20 min from ICI, suggesting a \u201clate-responder\u201d profile. Conclusion: If further studies confirm the existence of a distinct hemodynamic profile in patients with severe anxiety, sampling the PSV and the EDV values could be proposed, for detecting patients with severe anxiety-related ED. Dynamic PCDU could be considered an accurate diagnostic test in patients with non-organic ED, since zero false-positive results were found in the present study. PSV in the flaccid state is not able to discriminate between arterial- or non-organic ED.<\/jats:p>","DOI":"10.3390\/jcm10030402","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T09:49:21Z","timestamp":1611222561000},"page":"402","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Differences in Penile Hemodynamic Profiles in Patients with Erectile Dysfunction and Anxiety"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4599-8487","authenticated-orcid":false,"given":"Rossella","family":"Cannarella","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6950-335X","authenticated-orcid":false,"given":"Aldo E.","family":"Calogero","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2989-2618","authenticated-orcid":false,"given":"Antonio","family":"Aversa","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5217-9343","authenticated-orcid":false,"given":"Rosita A.","family":"Condorelli","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7113-2372","authenticated-orcid":false,"given":"Sandro","family":"La Vignera","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"NIH Consensus Conference (1993). Impotence. NIH Consensus Development Panel on Impotence. JAMA, 270, 83\u201390.","DOI":"10.1001\/jama.270.1.83"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1080\/13685538.2018.1434772","article-title":"Epidemiology and Risk Factors of Lower Urinary Tract Symptoms\/Benign Prostatic Hyperplasia and Erectile Dysfunction","volume":"22","author":"Calogero","year":"2019","journal-title":"Aging Male"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1080\/13685538.2018.1430758","article-title":"Lower Urinary Tract Symptoms\/Benign Prostatic Hyperplasia and Erectile Dysfunction: From Physiology to Clinical Aspects","volume":"21","author":"Calogero","year":"2018","journal-title":"Aging Male"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1038\/ijir.2014.34","article-title":"Psychological Determinants of Erectile Dysfunction among Middle-Aged Men","volume":"27","author":"Aghighi","year":"2015","journal-title":"Int. J. Impot. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12991-015-0074-y","article-title":"Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation","volume":"14","author":"Mourikis","year":"2015","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_6","first-page":"e13550","article-title":"Is Milder Psychological Stress Responsible for More Severe Erectile Dysfunction?","volume":"52","author":"Liao","year":"2010","journal-title":"Andrologia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1080\/13685538.2018.1432586","article-title":"Treatment of Lower Urinary Tract Symptoms\/Benign Prostatic Hyperplasia and Erectile Dysfunction","volume":"21","author":"Calogero","year":"2018","journal-title":"Aging Male"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/andr.12073","article-title":"Failure to attain stretched penile length after intracavernosal injection of a vasodilator agent is predictive of veno-occlusive dysfunction on penile duplex Doppler ultrasonography","volume":"3","author":"Yafi","year":"2015","journal-title":"Andrology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1111\/jsm.12958","article-title":"Variation in penile hemodynamics by anatomic location of cavernosal artery imaging in penile duplex Doppler ultrasound","volume":"12","author":"Pagano","year":"2015","journal-title":"J. Sex. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1111\/j.1743-6109.2007.00546.x","article-title":"The Role of Penile Color-Duplex Ultrasound for the Evaluation of Erectile Dysfunction","volume":"4","author":"Aversa","year":"2007","journal-title":"J. Sex. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/S0090-4295(91)80367-G","article-title":"Psychologic factors affect erectile response to papaverine","volume":"38","author":"Slob","year":"1991","journal-title":"Urology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j.1365-2605.1996.tb00481.x","article-title":"Anxiety-induced Failure in Erectile Response to Intracorporeal prostaglandin-E1 in Non-Organic Male Impotence: A New Diagnostic Approach","volume":"19","author":"Aversa","year":"1996","journal-title":"Int. J. Androl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S0090-4295(97)00238-0","article-title":"The International Index of Erectile Function (IIEF): A Multidimensional Scale for Assessment of Erectile Dysfunction","volume":"49","author":"Rosen","year":"1997","journal-title":"Urology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1210\/jc.2018-00229","article-title":"Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline","volume":"103","author":"Bhasin","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/j.1743-6109.2012.02825.x","article-title":"Standardization of Vascular Assessment of Erectile Dysfunction: Standard Operating Procedures for Duplex Ultrasound","volume":"10","author":"Sikka","year":"2013","journal-title":"J. Sex. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/S0009-9260(03)00112-0","article-title":"Colour Doppler Ultrasound of the Penis","volume":"58","author":"Wilkins","year":"2003","journal-title":"Clin. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.eururo.2006.07.015","article-title":"Association Between Erectile Dysfunction and Coronary Artery Disease: Matching the Right Target With the Right Test in the Right Patient","volume":"50","author":"Montorsi","year":"2006","journal-title":"Eur. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1001\/jama.294.23.2996","article-title":"Erectile Dysfunction and Subsequent Cardiovascular Disease","volume":"294","author":"Thompson","year":"2005","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1038\/sj.ijir.3900838","article-title":"The Limited Practical Value of Color Doppler Sonography in the Differential Diagnosis of Men with Erectile Dysfunction","volume":"14","author":"Slob","year":"2002","journal-title":"Int. J. Impot. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1038\/sj.ijir.3900477","article-title":"Re-dosing of Prostaglandin-E1 Versus Prostaglandin-E1 Plus Phentolamine in Male Erectile Dysfunction: A Dynamic Color Power Doppler Study","volume":"12","author":"Aversa","year":"2000","journal-title":"Int. J. Impot. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2623","DOI":"10.1111\/j.1743-6109.2008.00982.x","article-title":"Penile Doppler Ultrasound in Patients With Erectile Dysfunction (ED): Role of Peak Systolic Velocity Measured in the Flaccid State in Predicting Arteriogenic ED and Silent Coronary Artery Disease","volume":"5","author":"Corona","year":"2008","journal-title":"J. Sex. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/S0302-2838(01)00012-4","article-title":"Efficacy of virtual glasses in audio-visual sexual stimulation during penile color duplex Doppler ultrasonography","volume":"41","author":"Park","year":"2002","journal-title":"Eur. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/3\/402\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:13:31Z","timestamp":1760159611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/3\/402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,21]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["jcm10030402"],"URL":"https:\/\/doi.org\/10.3390\/jcm10030402","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,21]]}}}