Reports from the 2nd Pan-Arab Congress of Sexual Dysfunction, Cairo, January 29-31, 2003

by Luca Incrocci, M.D., Ph.D. The 2nd Pan-Arab Congress of Sexual Dysfunction, organized by the Pan-Arab Society of Genital Surgeons, follows the first successful meeting two years ago, also in Cairo. Under the patronage of the Ministry of Health and Population and of Tanta University, Dr Khaled Lofty Dabees organized a very interesting meeting giving the opportunity to Arab countries to enrich knowledge about recent aspects of urogenital surgery, sexual dysfunction and infertility. About 300 colleagues of whom 70 from countries other than Egypt participated in vivid discussions. Guest speakers from Europe completed the program. The meeting started with a workshop on erectile dysfunction (ED) granted by Pfizer, held by Egyptian colleagues which purpose was to update information on all aspects of ED. Dr Mettawae reported on the recent survey on sexual health that was worldwide conducted by Pfizer in 28 countries on 26,000 men and women, 40-80 years old. Eighty-two per cent of men and 64% of women were sexually active and about 70% weekly. About 40% of men and women reported sexual difficulties such as ED or lubrication problems in the previous 2 months. This survey also indicated that few doctors ask their patients about sexual problems. Although country differences were encountered, about 40% of the interviewed population expressed satisfaction with their sexual life; this percentage was higher in healthier people.

Dr Foda presented an extensive overview of the anatomy, pathophysiology and hemodynamic of erection, while Dr Sharaf, internist, stressed the relation between ED and dyslipidemia, recalling that per each mmol/L increase in total cholesterol the risk for ED increases 1,32 times. Dr Fayek, cardiologist, presented the American Consensus on ED and Cardiovascular Disease and the use of sildenafil. He concluded that sildenafil is safe, having no effect on cardiac contractility, heart rate, central hemodynamics and on platelets. The only contraindication remains the use of nitrates and unstable angina. This topic raised interesting discussions on the safety of sildenafil in different cardiovascular diseases. Dr Anis presented an extensive overview of the different evaluation methods for the patient with ED, even mentioning the obsolete penile brachial index testing. Dr Ghanem emphasized how often such tests are overdone and unuseful, stressing the importance of a good anamnesis, history taking, evaluation of the used drugs. He suggested a treatment-oriented approach starting giving an oral erectogenic agent, eventually together with sexual therapy, or a vacuum device, and proceeding to intracavernosal injections (ICI) and even penile implants, if necessary. I was impressed by the excellent quality of the lectures that reached the goal of the workshop.

The second day opened with a lecture on the prevalence of ED among Egyptian men over 40 years presented by Dr Khalaf. By performing a survey on prostate diseases, Egyptians were also asked about sexual functioning using three questions (IIEF 3, 4, 7). Among 5,069 men, almost 51% complained of some form of sexual dysfunction. From this survey it became clear that many religious misconceptions were present as well confusion between ejaculation disturbances and ED, and lack of sexual education. This survey showed as expected a correlation of ED with hypertension, heart diseases, diabetes mellitus and reumatic disease but no correlation with smoking. Dr Khalaf pointed out that of the interviewed men only 50% were smokers, though further statistical analyses did not show any correlation of ED and smoking. Dr Incrocci presented an extensive overview of incidence, etiology and prevention of sexual dysfunction following treatment of prostate cancer. The Arab colleagues found it very interesting because knowledge on this important topic is still limited. Dr Dabees presented an excellent overview of future trends in ED therapy. He stressed that in the future a combination of treatment modalities will be used such as sildenafil and apomorphine, or sildenafil and ICI to optimize treatment and satisfy the patient. Dr Dabees also presented the different experimental drugs being evaluated at the moment in phase I-II trials. His take-home message was to first eliminate risk factors before any therapy is started. Dr Tritto presented the futuristic, but possible use of bio-engineering and microtechnology for male reconstructive surgery while he sceptically addressed gene therapy for ED that does not seem to be easy (and maybe even safe) to perform.

Peyronie?s Disease (PD) was addressed in two state-of-the-art lectures; after an excellent overview on the etiology, pathophysiology, evaluation and medical therapy of PD by Dr El-Behnasawy, Dr Incrocci presented a critical overview on radiotherapy for PD still debatable but effective.

Female Sexual Dysfunction (FSD) was an important topic at the meeting. Dr Graziottin presented interactive case studies on evaluation and therapy of dyspareunia, chronic vestibulitis and other FSDs. She also addressed the topic of the overactive bladder and sexual dysfunction. She stressed that incontinence is still a taboo, because it is the failure of control and of physical integrity. Women with urine incontinence have an impairment of their body image because of fear of urine leak and smell. This situation impairs sexual functioning, specifically orgasm because of urine incontinence at the climax. Dr Graziottin also said that topical estrogen-androgen combination is very useful in post-menopausal women for local application when the clitoris is not functioning anymore while it can be systemically used in case of libido and orgasm disturbances. Sildenafil seems to improve arousal in pre-menopausal women (Dr Drettas). The meeting presented also state-of-the-art lectures and podium presentations on fertility/infertility, addressing advantages and disadvantages of new techniques. Also interesting podium presentations on ED completed the program.

In conclusion, the meeting was an excellent opportunity for Arab colleagues to be updated on evaluation and treatment of sexual dysfunction in males and females. The organization was very good, the location was great in a beautiful hotel overlooking the pyramids so everybody enjoyed the atmosphere. I am looking forward to the 3rd meeting in 2004.