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APSSM Objectives

• To improve standards of clinical care and quality of life for patients suffering from sexual dysfunction in Asia Pacific countries
• To encourage scientific research to benefit the general public in Asia Pacific countries
• To serve as an information resource and communication base between member countries
• To promote fellowship of its membership
• To promote an international drive to improve the quality of life of men and women with sexual dysfunction in the world
• To ensure that the Society’s activities are not of a political nature and that no profit is made by the Society

Message from the Editor

The Asia Pacific Society for Sexual Medicine (APSSM) is proud to publish this First Issue of its very own bi-annual APSSM Newsletter.

In addition to being an effective medium of communication between the Executive Council and members of the Society and providing an important interface between the Society and the general medical and para-medical fraternities, the APSSM Newsletter will promote fellowship within its membership and enhance its bonding.

APSSM is the peak organisation for sexual medicine for the Asia Pacific region, which sustains 60% of the world’s population with diverse ethnic, cultural and religious backgrounds, tradition and practice. It is one of the oldest societies dedicated to research and education in sexual medicine.

It is hoped that the Newsletter will serve as a record of the robust activities of the Society, a notice board for the announcement of upcoming events, a forum for the free expression of views, and an archive for research and educational articles.

Columns such as “Letter to the Editor” and “As I was saying…” will be interesting add-ons whenever demands occur.

Comments and suggestions are welcome. Please send all correspondence and submissions to the Editor at:
kewkimchew@hotmail.com.
APSSM News Bulletin APSSM News Bulletin Issue 1 2006

APSSM Activities
Information regarding APSSM, its activities and its recent announcements can be accessed at the APSSM website:
www.apsir.org.

The following are the highlights from the Secretary-General’s report and the reports of various Committee Chairs:

Secretariat
Secretary-General: Hui Meng Tan

• Draft copy of new by-laws is being considered by the Executive Council.
• Organisation of the 2nd APSSM Regional Scientific Meeting in India in December 2006 is in progress. The 3rd Scientific Meeting will be held in 2008 in China.
• Collection of APSSM and International Society for Sexual Medicine (ISSM) membership fees is well in hand. Deadline for payment has been extended to end of February 2006.
• Six Local Conference Grants are available for 2006.
• APSSM website has been updated.
• APSSM Financial Report for 2005 and Budget for 2006 have been submitted to ISSM.
• Nine APSSM Research Grants were awarded for 2005.
• The 11th Biennial Meeting of APSSM will be held in Korea in 2007, and the 12th Biennial Meeting in Singapore.

Audit Committee
Chair: Sudhakar Krishnamurti

• Recommendations were made regarding foreign exchange charges and quotations for projects.

Scientific and Research Committee
Chair: Kwang Sung Park

• The four awardees of the 2005 APSSM Travel Grants of USD3,000 each, selected from nine applications, were: Sudhakar
• Details of 2006 APSSM Travel and Research Grants are available at APSSM website.

By-Laws Committee
Chair: Peter Lim

• Draft copy of new by-laws is being considered by the Executive Council.

Website Committee
Chair: Sung Won Lee

• Ways of improving and updating current website will be considered.

Membership Committee
Chair: Han Sun Chiang

• Strategies for membership drive are being considered.
• APSSM membership at a special rate comes with membership of ISSM and all the privileges of both Societies.
  Krishnamurti, Jihong Liu, Srilatha Balasubramaniam and Wah Yun Low.
• Nine APSSM Research Grants of USD5,000 each were awarded for 2005 and were as follows:
   

Development Committee
Chair: Ken Marumo

• Six grants of USD 5,000 each are available for travel to relevant national conferences on sexual medicine and men’s health.

Publications Committee
Chair: Kew Kim Chew

• Regular updates on APSSM activities were provided for the ISSM Newsbulletin.
• A similar update was published in the Asian Journal of Andrology.
• An update on APSSM activities and a report on the 9th Biennial Meeting of the Society were published in Issue 11 of the InformED Newsletter.
• The Committee was charged with the responsibility of publishing the APSSM Newsletter biannually.

The 10th Biennial Meeting of APSSM
The 10th Biennial Meeting of APSSM was held at the internationally acclaimed Cairns Convention Centre on 4th to 8th October 2005 in the resort city of Cairns in Australia. It was hosted by the Keogh Institute for Medical Research, which is based in Perth, Australia. Carolyn Earle was Chair of the Organising Committee, with the awardwinning Promaco Conventions as conference organisers. Kim Chew was in charge of the Scientific Programme, and the Faculty included a panel of international opinion leaders in sexual medicine, in addition to the invited plenary and symposium speakers.

The Scientific Programme with the theme ‘Old Problems – New Solutions’ comprised:

(a) 12 plenary lectures on a wide range of topical issues
(b) 4 issue-specific symposia complemented by symposia presented by the Asia Pacific Society for the Study of the Aging Male (APSSAM), Andrology Australia, Bayer Healthcare, Lilly-Icos and Pfizer
(c) an innovative debate sponsored by the Journal of Sexual Medicine
(d) podium presentations of a selection of free papers on research and management in sexual medicine and men’s health.

Various aspects of sexual dysfunction in both men and women were comprehensively addressed. The relevance and significance of erectile dysfunction in multi-system endothelial disease were emphasised. The role and impact of sex therapy and of oncology on sexual function and dysfunction were highlighted. Iatrogenic factors in sexual
dysfunction were deliberated and the place of complementary medicine, pertinent particularly to the Asia Pacific region, was discussed.

The Abstracts of all the presentations were included in the Book of Program & Abstracts prepared for the Meeting delegates and are available at the Society’s website. They will be published in a Supplement of the Journal of Sexual Medicine.

In addition to the great variety of social, recreational and cultural opportunities available in Cairns and its precincts, the Social Programme of the Meeting, with the Opening Ceremony, Welcome Reception, Gala Dinner at the Tjapukai Aboriginal Theme Park, and invitation-only Faculty Dinner at the Red Ochre, was exciting and memorable.

The Meeting was generously supported by Bayer Healthcare, Eli Lilly, Pfizer, American Medical Systems, Johnson & Johnson, Schering and Mentor, with sponsorships, displays and social as well as educational activities.

From the feedback received, the Meeting earned the approval of all concerned and was a resounding success.

Some Highlights from the 10th APSSM Meeting
Adapted from slides for ‘Daily Highlights’ prepared by Stephen Adams, Sudhakar Krishnamurti and Warrick White.
 

Snapshots from the Cairns Meeting

The President, President-Elect & Secretary-General at EXCO Meeting in Cairns.	The Chair of Organising Committee of the 10th APSSM Meeting speaks.
Starting a fire at the Tjapukai Aboriginal Theme Park.	Happy faces!
Happy faces!

2nd Regional APSSM Scientific Meeting and 1st AGASSI* Conference
The 2nd Regional Scientific Conference of the APSSM will be held concomitantly with the 1st AGASSI (www.agassi.in) Conference at the Hilton Towers, Mumbai, India, on
December 2nd and 3rd 2006. A live pre- or post-conference operative workshop is being considered.

AGASSI is a new multi-disciplinary society which deals with sexual medicine, both clinical and basic, in addition to allied sub-specialties.

Formed with the support of experts and professionals from both within and outside India, AGASSI hopes to become the flagship  academic platform for sexual medicine and
other allied sub-specialties in the Indian sub-continent. It hopes to eventually affiliate itself with similar regional and international societies.

An interesting scientific program is being planned, and some leading international experts have already confirmed their participation. The aim of this event is to make the Regional Scientific Conference an important scientific and academic APSSM event and to kick-start and promote AGASSI.

Mumbai is a well-connected city and has already hosted many large international medical conferences in the past. In addition, it is also the hub for tourism to other parts of India.

For further information or expression of interest, please access www.apsir.org or www.agassi.in, or email the undersigned at:
andrologist@gmail.com.

Dr. Sudhakar Krishnamurti
(andrologist@gmail.com)
Organising Chairman
2nd Regional Scientific APSSM and 1st AGASSI Conference
www.sudhakarkrishnamurti.com

* The Ageing, Gender, Andrology & Sexual Sciences
Society of India

Reports of 2004 APSSM Research Grant Awardees
Due to space constraints, only the salient aspects of each report are published. Further details may be obtained from the awardees concerned through the Scientific & Research Committee.

• Effects of combined treatment with antioxidant and gene transfer on erectile function of rats with generalised atherosclerosis
– Soo Woong Kim

Hypotheses:

1. Intracavernosal injection of cDNA of type 2 dimethylarginine dimethylaminohydrolase-2 (DDAH-2) will lead to an increase in the expression of DDAH-2 in treated rats.

2. Antioxidant therapy will lead to an increase in DDAH activity in treated rats.

3. Combined treatment may lead to a decrease in cavernosal asymmetric dimethylarginine (ADMA) accumulation.

4. If the above assumptions prove correct, the atherosclerotic rats will show a restoration in erectile function due to increased cavernosal nitric oxide synthase (NOS) activity.

Results/Conclusion:
Combination treatment of DDAH-2 gene transfection with vitamin E supplement resulted in amelioration of erectile dysfunction by diminishing ADMA levels and increasing NOS activity. Results demonstrated that DDAH-2 gene expression combined with measures to reduce oxidative stress may be a favourable therapeutic strategy to treat erectile
dysfunction.

• A randomised, double-blind, parallel-group, placebo-controlled study evaluating the physiologic changes and safety of 20mg tadalafil administered every other day for 144 hours compared to placebo in healthy subjects with or without visual sexual stimulation
  – Jong Kwan Park

Method:
Ten healthy males were enrolled in the study, 5 were treated with 20mg of tadalafil (group I) and had visual stimulation 90 minutes after medication and the other 5 were treated with 20mg of tadalafil but did not have visual stimulation (group II). Blood was sampled before medication, and 1, 2, 4, 8, 24, and 36 hours after medication. Analyses were conducted on blood pressure and pulse rates, the plasma cyclic guanosine monophosphate (cGMP), cyclic adenosine monophosphate (cAMP), atrial natriuretic peptide and aldosterone.

Results/Conclusion:
Cyclic GMP but not cAMP was increased 1, 2, 4, 8, 24, and 36 hours after medication of tadalafil 20mg. There were no statistical differences between the 2 groups.

• Effect of oestrogens on intracellular cAMP and cGMP pathways in rat erectile tissue – Srilatha Balasubramaniam

This study evaluated the effect of oestrogens compared with testosterone (T) on intracellular cAMP and cGMP levels in order to understand the specific effect of oestrogen(s) on these final mediators of male erectile pathophysiology.

Specifically, this project studied the intracellular release of cAMP and cGMP in the presence of T, oestradiol (E2) and the dietary phytoestrogen daidzein to delineate the impact of hormonal derangement on the cellular changes of erectile dysfunction (ED).

The results indicated statistically significant modulations in the cavernosal cAMP (increase) and cGMP (decrease) by E2/daidzein while testosterone significantly enhanced cGMP release. This study explains the cellular mechanism for the potential aetiological role of oestrogen in ED.

Together with the androgen decline manifesting as reduced libido and erectile impairment, the elevated oestradiol per se in aging may further compound ED; similar changes could be expected from inadvertent dietary intake of phytoestrogens.

• Age-related changes of nitric oxide synthase isoforms and endothelin-1 in rat corpus cavernosum – Hyun Jun Park, Bu Kyung Park, Nam Cheol Park

Purpose of Study:
Relaxation of penile cavernous smooth muscle, which is the primary process in penile erection, is controlled by endothelial derived substances. This study was designed to determine whether aging resulted in altered endothelial autocrine/paracrine function.

Results/Conclusion:
The activation of vascular endothelin cascade and alterations in expression of NOS isoforms may play an important role in age-dependent vasculogenic erectile dysfunction.

• Novel animal model of Peyronie's Disease by tunical injection of autologous blood – Bae JH, Moon DG, Kim YS, Kim JJ

Purpose:
The production of fibrous plaque in tunica albuginea (TA) of rabbits is attempted as a potential animal model of Peyronie's disease (PD).

Results/Conclusion:
Autologous blood can induce a reliable PD-like condition in the rabbit model. With further refinement, an autologous blood-induced animal model may be used as an experimental model for PD.

• The role of haeme oxygenase-1 in artificially induced low-flow priapism in rat penile tissues – Jae Seog Hyun, Sae Min Choi and Sung Chul Gam

Purpose:
In order to investigate role of haeme oxygenase (HO)-1 in a low-flow priapism model, the expression and activity of HO-1 were examined in artificially induced veno-occlusive priapism in rat penile tissues.

Results/Conclusion:
A higher induction of HO-1 with time was observed in artificially induced veno-occlusive priapism; this may play a protective role against hypoxic injury and importantly, may also play a critical role in the vicious circle observed in low flow priapism.
 

A New Direction in Sexual Medicine:
Lifestyle Diseases and Erectile Dysfunction

Based on a presentation by the Editor at the Japanese Society for Sexual Medicine/Pfizer Japan Symposium in Tokyo on 15th September 2005.

Lifestyle factors have brought about considerable changes in the epidemiology of disease in the global community and in the pattern and level of health risk for the individual. Diet, exercise, cigarette smoking, alcohol and recreational drugs are known to have serious implications in male sexual function in addition to their well-documented association with a wide range of morbidities.

A diet high in calories and saturated fats readily leads to weight gain, which is often made worse by the compounding effect of low physical activity encouraged by advances
in automation technology. In Australia, 67.4% of men over the age of 25 years are overweight with a body mass index (BMI) of ≥25, and 19.1% are obese (BMI ≥30).1

Obesity, probably more aptly measured by the waist circumference or the waist/hip ratio,2 is the most prominent and physically visible component of the Metabolic Syndrome.

Pathophysiologically, the Metabolic Syndrome is characterised by a decrease of tissue sensitivity to the action of insulin, with consequently compensatory hyperinsulinaemia. This leads to various permutations of obesity, type 2 diabetes mellitus, dyslipidaemia and cardiovascular disease. Statistical data in Australia show that, among men aged 25
years and older, 8.7% have diabetes mellitus (type 1 and 2), 51.5% have hypercholesterolaemia (>5.5 mmol/L), and 32.3% have high blood pressure (≥140/90 mm.Hg).1

Male sexual dysfunction comprises erectile dysfunction (ED) and disorders of libido, ejaculation and orgasm. As many risk factors are common to both cardiovascular disease and male sexual dysfunction, particularly ED,3,4 and as the Metabolic Syndrome is significantly implicated in the pathogenesis of cardiovascular disease,2,5 it is conceivable that ED would be prevalent in men with the various clinical components of the Metabolic Syndrome.

A decline in libido in men may be related to decreased plasma testosterone levels associated with obesity and sleep apnoea. Retrograde, retarded and absent ejaculation may be attributable to the Metabolic Syndrome through, for instance, the development of diabetic autonomic neuropathy and the use of medications.

As well as being significantly implicated in cardiovascular disease,2,5 obesity and dyslipidaemia are associated with a higher prevalence of ED.6,7 There is now mounting evidence that endothelial dysfunction associated with the Metabolic Syndrome constitutes the pathophysiological basis of most vasculogenic ED.  Stratifying the levels of C-Reactive Protein (CRP), a marker of systemic vascular inflammation, in patients with the Metabolic Syndrome, diabetes mellitus or obesity has been shown to enhance the predictive or prognostic information regarding their risk for ED.9,10

In Australia, 21.1% of men aged 25 years and older smoke cigarettes and tobacco products, and smoking is responsible for the greatest disease burden in Australia, accounting for 12% in Australian men.1 Although there are decreasing numbers of smokers over recent years, of concern is the finding that most smokers are now in the younger age groups. 82.4% of Australians drink alcohol, but only 8.3% are daily drinkers. Excessive alcohol consumption is a major risk factor for morbidity and mortality. It is difficult to accurately assess the level of use of recreational drugs.

A study on ED in general medical practice had previously been conducted in Perth, Western Australia.11 A community-based Western Australia Men’s Health Study was recently concluded with its major focus on ED and its socio-demographic and clinical correlates.12

Based on the 5-item International Index of Erectile Function (IIEF-5) scores, the prevalence of ED among West Australian males in the community aged 20 years and older was found to be 25.4% (IIEF-5 <22), and 8.7% had severe ED (IIEF-5 <8). The results of both studies confirmed yet again the significant correlation of ED with cardiovascular disease, diabetes mellitus and cigarette smoking.

Strategies have to be planned and opportunities seized to address and modify lifestyle factors in the preventive and therapeutic management of sexual dysfunction in general and ED in particular.

The Asian EDACT Committee of the APSSM
The Asian Erectile Dysfunction Advisory Council and Training (EDACT) Group, having accomplished its mission for a decade, will henceforth continue to function as the EDACT Committee within the Asia Pacific Society for Sexual Medicine (APSSM).

With the publication of the 11th Issue, the InformED is now officially the APSSM Newsletter.

Further educational activities are being considered and will be reported in these pages.

Asian EDACT Mission Statement
To develop Asian-specific programmes to help improve awareness, understanding and management of erectile dysfunction, and to enhance quality of life of patients with erectile dysfunction.

Asian EDACT Members
Dato’ Tan Hui Meng, Kuala Lumpur
Choi Hyung Ki, Seoul
Chen Kuang-Kuo, Taipei
Denis Cherry, Perth
Yasusuke Kimoto, Fukuoka
Sudhakar Krishnamurti, Hyderabad
Akmal Taher, Jakarta
Apichat Kongkanand, Bangkok
Benjamin Mendoza, Manila
Zhu Ji Chuan, Beijing
Li Man Kay, Singapore
Young Chan Kim, Seoul
Yip Wai-Chun, Hong Kong
Akihiko Okuyama, Osaka

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