«Chapter 2 / Epidemiology of ED 47 2 Epidemiology of Erectile Dysfunction Ridwan Shabsigh, MD SUMMARY Erectile dysfunction (ED) is a highly prevalent ...»
In conclusion, ED is a highly prevalent condition, the incidence is strongly associated with age, and it is progressive and undertreated. Although the general impact on a society Chapter 2 / Epidemiology of ED 55 is immense, costs may be containable, and the effects on quality of life of patients, their partners, and society are highly favorable.
TREATMENT-SEEKING BEHAVIORBehavioral factors significantly influence the behavior of patients with ED as well as their partners. This influence ranges from attitudes toward diagnosis, treatment-seeking behavior, and, ultimately, treatment compliance and dropout. In one study, Althof stated that the high rate of discontinuation for men receiving treatment for ED (50–60%) could not be explained by inefficacy. Althof explored psychological reasons for dropout and proposed seven factors that may explain why men, women, and couples resist continued treatment (61,62). In another study, 30 of 47 patients successfully treated with intercavernous vasoactive agents responded to a self-questionnaire regarding their reasons for dropping out of the program. The authors concluded that discontinuation did not result from treatment-related problems (63).
Another two studies showed a factor that might affect dropout or noncompliance as the tendency to attribute one’s problems to external factors (i.e., the partner); therefore, the alleviation of the problem might not be properly attributed to medical intervention (64,65). A Japanese study specifically addressed patient attitudes toward ED treatment through a national mail survey sent to married couples ages 30 to 79 yr. Of the 2034 males and 1820 females who responded to questions about the male’s sexuality, 29.9% of males felt they had ED and 30.1% of females felt their husbands had ED. A low percentage of those who responded sought treatment; only 4.8% of male sufferers had consulted a physician. Reasons cited might be include culture (“shyness,” “should be covered by insurance,” or “not bothered by ED;” ref. 66).
In a study using questionnaires sent to 108 patients, 100 (93%) responded. Researchers looked at hospital records and data from the survey. Only 32% continued self-injection treatment, about half of those (56%) discontinued within the first year, and patients who stopped therapy were significantly older and had poor initial impressions of therapy.
Similarly to other studies, the authors concluded that dropout had little to do with side effects or etiology (67). In a study of 195 men comparing treatment compliance and treatment choice with marital satisfaction using the Maudsley Marital Questionnaire, no differences were found between the four groups tested: patients on intracavernosal injection treatment, patients who dropped out during the trial-dose phase, patients on other treatment, and patients who renounced treatment after first counseling. However, in the patients treated with intracavernosal injections, efficacy was increased by offering information and enabling couple communication (64). Finally, a survey of depressive symptoms in patients presenting with ED suggested that patients suffering from ED who had high depressive scores were more likely to discontinue treatments for ED (58).
In the Cross-National Survey on Male Health Issues (18,25,65), the aim was to describe the motivators and barriers influencing treatment-seeking behavior in men with ED.
Screening included 32,644 men. Follow-up questionnaires were completed by 2831 men who suffered from ED. Men were recruited in waiting rooms in general practice offices.
Treatment-seeking among men who suffered from ED was highest among Spanish men (48%) and lowest for German and Italian men (27 and 28%, respectively). Rate of current ED medication use among men suffering from ED was quite low across all countries, ranging from only 8% in France and Italy to 14% in the United States.
56 Shabsigh The top three barriers to seeking ED treatment were the belief that ED was a normal part of aging, the belief that the condition would resolve on its own, and embarrassment.
Older men were more likely to view ED as a normal condition, and younger men were more likely to hope that their ED would resolve on its own. Once they perceived an erection problem, men waited many months before seeking treatment, ranging from just over 1 yr in Italy to almost 3 yr in the United Kingdom. Several barriers continue to influence treatment-seeking behavior in men with ED, resulting in low rates of utilization and high rates of dropout for therapies for ED. Further research in this field is urgently necessary.
CONCLUSIONED is highly prevalent among men, regardless of geography or ethnicity. Its prevalence and incidence are associated with aging, cardiovascular disease, diabetes, hyperlipidemia, lifestyle issues (such as smoking, alcohol abuse, obesity, and sedentary lifestyle), depression, pelvic surgery, neurological disorders, trauma, symptoms of benign prostatic hyperplasia, side effects from medication, and psychological and interpersonal factors.
The severity of ED is also a prognostic marker of important medical diseases. ED has a significant negative impact on the quality of life of patients and their partners. Treatmentseeking behavior is influenced negatively by certain barriers, including the belief that ED is a normal part of aging, denial, and embarrassment.
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