FREE ELECTRONIC LIBRARY - Dissertations, online materials

Pages:     | 1 | 2 || 4 |

«Chapter 2 / Epidemiology of ED 47 2 Epidemiology of Erectile Dysfunction Ridwan Shabsigh, MD SUMMARY Erectile dysfunction (ED) is a highly prevalent ...»

-- [ Page 3 ] --

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.


Behavioral 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.


ED 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.


1. National Institutes of Health Web site. Impotence. NIH Consensus Statement. 1992; 10: 1–31. Available at: http://consensus.nih.gov/cons/091/091_statement.pdf. Accessed 5/15/2004.

2. Prins J, Blanker MH, Bohnen AM, Thomas S, Bosch JLHR. Prevalence of erectile dysfunction: a systematic review of population-based studies. Int J Impot Res 2002; 14: 422–432.

3. Kubin M, Wagner G, Fugl-Meyer AR. Epidemiology of erectile dysfunction. Int J Impot Res 2003;

15: 63–71.

4. Nusbaum MRH. Erectile dysfunction: prevalence, etiology, and major risk factors. J Am Osteopath Assoc 2002; 102(Suppl 4): S1–S6.

5. Braun M, Wassmer G, Klotz T, et al. Epidemiology of erectile dysfunction: results of the Cologne male survey. Int J Impot Res 2000; 12: 305–311.

6. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States. Prevalence and predictors.

JAMA 1999; 281: 537–544.

7. Giuliano F, Chevret-Measson M, Tsatsaris A, et al. Prevalence of erectile dysfunction in France: results of an epidemiological survey of a representative sample of 1004 men. Eur Urol 2002; 42: 382–389.

8. Low WY, Wong YL, Zulkifli SN, et al. Malaysian cultural differences in knowledge, attitudes and practices related to erectile dysfunction: focus group discussions. Int J Impot Res 2002; 14: 440–445.

9. Martin-Morales A, Sanchez-Cruz JJ, Saenz de Tejada I, et al. Prevalence and independent risk factors for erectile dysfunction in Spain: results of the ‘Epidemiologia de la disfuncion erectil study.’ J Urol 2001; 166: 569–575 (poster 171).

10. Hackett GI, Milledge D. A 12-month follow up of 260 patients taking sildenafil. NHS clinical experience. In: Fourth Congress of the European Society for Sexual and Impotence Research (ESSIR), Rome, September 30–October 3, 2001.

11. Casabe A, Cobreros C, Bechara A, et al. Drop out reason in responders to sildenafil. Int J Impot Res 2001; 13(Suppl 2): S5.

12. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54.

13. Seftel, AD, Sun P, Swindle R. The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol 2004; 171: 2341.

14. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004; 291: 2978.

Chapter 2 / Epidemiology of ED 57

15. Rosen R, Altwein J, Boyle P, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 2003; 44: 637.

16. Khan MA, Morgan RJ, Mikhailidis DP. Sexual dysfunction in men with lower urinary tract symptoms and benign prostatic hyperplasia: an emerging link. BJU Int 2003; 92: 822.

17. Braun MH, Sommer F, Haupt G, Mathers MJ, Reifenrath B, Engelmann UH. Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical “Aging Male” symptoms? Results of the Cologne Male Survey. Eur Urol 2003; 44: 588.

18. Shabsigh R, Perelman MA, Laumann EO, Lockhart DC. Drivers and barriers to seeking treatment for erectile dysfunction: a comparison of six countries. BJU Int 2004; 94: 1055–1065.

19. Chew KK, Earle CM, Stuckey BGA, Jamrozik K, Keogh EJ. Erectile dysfunction in general medicine practice: prevalence and clinical correlates. Int J Impot Res 2000; 12: 41.

20. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey.’ Int J Impot Res 2000; 12: 305.

21. Nicolosi A, Moreira ED Jr, Shirai M, Bin Mohd Tambi MI, Glasser DB. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology 2003; 61: 201.

22. Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human male. WB Sanders, Philadelphia, 1948.

23. McKinlay JB, DiGruttolo L, Glasser D, et al. International differences in the epidemiology of male erectile dysfunction. Int J Impotence Res 1998; 10(Suppl 3): S42.

24. Shabsigh R, et al. Economical aspects of sexual dysfunction. In: Lue TF, Rosen R, Giuliano F, Khouri S, Montorsi F. Sexual Medicine: Sexual Dysfunction in Men and Women, 2nd International Consultation on Sexual and Erectile Dysfunction co-sponsored by the World Health Organization (WHO), International Society of Sexual and Impotence Research (ISIR) and Societe Internationale d’Urologie (SIU), Health Publications Ltd, Paris, 2004.

25. Shabsigh R, Perelman M, Lue TF, Broderick GA, Lockhardt D. Men’s health issues: prevalence and correlates of erectile dysfunction. J Urol 2005; 174: 662–667.

26. Woong Kim S, Paick J, Park DW, Chae I, Hee Oh B. Potential predictors of asymptomatic ischemic heart disease in patients with vasculogenic erectile dysfunction. Urology 2001; 58: 441–445.

26a. Oaks WW, Moyer JH. Outpatient management of hypertension. WV Med J 1965; 61: 6–10.

26b. Wabrek AJ, Burcell RC. Male sexual dysfunction associated with coronary heart disease. Arch Sex Behav 1980; 9: 69–75.

27. Burchardt M, Burchardt T, Baer L, et al. Hypertension is associated with severe erectile dysfunction.

J Urol 2000; 164: 1188–1191.

28. Burchardt M, Burchardt T, Baer L, et al. Erectile dysfunction is a marker for cardiovascular complications and psychological functioning in men with hypertension. IJIR 2001; 13: 276–281.

29. Shabsigh R, Klein LT, Seidman SN, Kaplan SA, Lehrhoff B, Ritter JS. Increased incidence of depressive symptoms in men with erectile dysfunction. Urology 1998; 52: 848–852.

30. Mirone C, Imbimbo A, Bortolotti E, et al. Cigarette smoking as risk factor for erectile dysfunction:

results from an Epidemiological Study. Eur Urol 2002; 42: 1–4.

31. Shabsigh R, Fishman IJ, Schum C. The role of cigarette smoking and other vascular risk factors in the pathogenesis of impotence. Urology 1991; 38: 227.

32. Tengs T, Osgood N. The link between smoking and impotence: two decades of evidence. Prev Med 2001;

32: 447–452.

33. Meuleman EJH, Mulders PFA. Erectile dysfunction after radical prostatectomy: a review. Eur Urol 2003; 43: 95–102.

34. Shabsigh R, Anastasiades A. Erectile dysfunction. Ann Rev Med 2003; 54: 153–168.

35. Sexual Dysfunction Therapeutics. A Market Overview and Therapeutic Analysis 2002. Frontline Strategic Consulting, Inc., San Mateo, CA. Available from: info@frontlinesmc.com. Accessed Nov. 2002.

36. Plumb JM, Guest, JF. Annual cost of erectile dysfunction to the UK Society. Pharmacoeconomics 1999;

16(6): 699–709.

37. Wilson EC, McKeen ES, Scuffham PA, Wylie K, Hacket G. The cost to the United Kingdom National Health Service of managing erectile dysfunction: impact of sildenafil and prescribing restrictions. Pharmacoeconomics 2002; 20(13): 879–889.

58 Shabsigh

38. Ashton-Key M, Sadler M, Walmsley B, Holmes S, Randall S, Cummings MH. The UK department of health guidance on prescribing for EDED following the introduction of sildenafil: potential to contain costs in the average health authority district. Pharmacoeconomics 2002; 20(12): 839–846.

39. Fendrick AM. Access to innovative treatment of erectile dysfunction: clinical, economic and quality of life considerations. Am J Manage Care 2000; 6(Suppl 12): S632–S638.

40. Tan Hue Meng Lin. Economic cost of male erectile dysfunction using a decision analytic model: for a hypothetical managed-care plan of 100,000 members. Pharmacoeconomics 2000; 17: 77–107.

41. Stolk EA, et al. Cost utility analysis of sildenafil compared with papaverine-phentolamine injections.

BMJ 2000; 320: 1165–1168.

42. Smith RJ, Roberts MS. The cost-effectiveness of sildenafil. Ann Intern Med 2000; 132: 933–937.

43. Litwin MS, Hays RD, Fink A, et al. Quality-of-life outcomes in men treated for localized prostate cancer. JAMA 1995; 273: 129–135.

44. Gralnek D, Wessells H, Cui H, et al. Differences in sexual function and quality of life after nerve sparing and non-nerve sparing radical retropubic prostatectomy. J Urol 2000; 163: 1166–1170.

45. Calais Da Silva F, Marquis P, Deschaseaux P, et al. Relative importance of sexuality and quality of life in patients with prostatic symptoms. Eur Urol 1997; 31: 272–280.

46. Zlotta AR, Schulman CC. BPH and sexuality. Eur Urol 1993; 36(Suppl 1): 107–1l2.

47. Burger B, Weidner W, Altwein JE. Prostate and sexuality: an overview. Eur Urol 1999; 35: 117–187.

48. Rosas SE, Joffe M, Franklin E, et al. Prevalence and determinants of erectile dysfunction in hemodialysis patients. Kidney Int 2001; 59: 2259–2266.

Pages:     | 1 | 2 || 4 |

Similar works:

«Assertiveness Training: Let Your Voice Be Heard! FACILITATOR GUIDE Developed by: University of Wisconsin Oshkosh Center for Career Development (CCDET) Wisconsin Department of Health Services Division of Quality Assurance Permission is granted to reproduce these training materials with proper attribution for internal use within healthcare organizations or government agencies at no cost to the training participants. Other reproduction is prohibited without written permission from UW Oshkosh...»

«October 2009 Responding to Sexual Violence: pathways to recovery. Authors: Venezia Kingi and Jan Jordan Commissioned by the Ministry of Women’s Affairs Responding to sexual violence: Pathways to recovery Venezia Kingi and Jan Jordan with Tess Moeke-Maxwell and Peggy Fairbairn-Dunlop Disclaimer This report was commissioned by the Ministry of Women‟s Affairs. The views, opinions and conclusions expressed in the report are intended to inform and stimulate wider debate. They do not represent...»

«For Patients What You Need to Know About LEMTRADA® (alemtuzumab) Treatment: A Patient Guide Patients: Your doctor or nurse will go over this patient guide with you. It is important to ask any questions you might have prior to each time LEMTRADA® (alemtuzumab) is given to you. Keep this guide for important safety information about the serious risks and reactions of LEMTRADA. Healthcare Providers: Review this patient guide with your patient prior to each treatment course, and provide your...»

«Approval Date: March 31, 2003 FREEDOM OF INFORMATION SUMMARY NADA # 141-193 ZUBRIN Tepoxalin Rapidly-Disintegrating Tablets For Dogs “ for the control of pain and inflammation associated with osteoarthritis.” SCHERING-PLOUGH ANIMAL HEALTH 1095 Morris Ave. P.O. Box 3182 Union, N.J. 07083-1982 TABLE OF CONTENTS: Page 1. GENERAL INFORMATION 3 a. Dosage Form, Route of Administration, and Dosage 3 b. Indications for Use 4 2. EFFECTIVENESS 4 a. Dosage Characterization 4 b. Substantial Evidence...»

«THIRTY YEARS OF DISDAIN How HHS and A Group of Psychiatrists Buried Myalgic Encephalomyelitis Mary Dimmock Matthew Lazell-Fairman December 2015 What I would most like to see is that fatigue is not abandoned as a subject for careful consideration because of further failures of CFS case definitions or frustrations arising out of shrill pressures to justify an entity of dubious validity.1 —Stephen Straus of the U.S. National Institute of Health (~1994) Preface 3 Matthew’s Story 5...»

«University of Missouri Health System Missouri Bariatric Services Guidelines Before & After Vertical Sleeve Gastrectomy Table of Contents Topic Page Risks & Benefits of Weight Loss Surgery 3 Guidelines for Your Hospital Stay, Self-Care, & Medications 8 Day of Surgery Expectations 8 What to Expect During Your Hospital Stay 9 Taking Care of Yourself at Home 10 Nutrition Guidelines Before & After Weight Loss Surgery 14 Basic Nutrition Information all Patients Should Know 15 Guidelines for Success...»

«ANNUAL REPORT 2 015 MARCH 2016 TO OUR SHAREHOLDERS ALEX GORSKY Chairman, Board of Directors and Chief Executive Officer WRITTEN OVER This year at Johnson & Johnson, we are proud this aligned with our values. Our Board of 70 YEARS AGO, to celebrate 130 years of helping people Directors engages in a formal review of OUR CREDO everywhere live longer, healthier and happier our strategic plans, and provides regular UNITES & lives. As I reflect on our heritage and consider guidance to ensure our...»

«Medical & Dental Education Office Altnagelvin Area Hospital Glenshane Road Londonderry BT47 6SB Tel: 028 7134 5171 ext 214185/213655 Fax: 028 7129 6159 GENERAL INFORMATION GUIDE FOR UNDERGRADUATE MEDICAL STUDENT PLACEMENTS: ALTNAGELVIN AREA HOSPITAL Issued by: Medical & Dental Education Office Date Revised: January 2014 1 Contents 1. INTRODUCTION 1.1 Administration in Altnagelvin 1.2 Western Health and Social Care Trust (WHSCT) 1.3 Altnagelvin Area Hospital 2. TEACHING FACILITIES 2.1 Ward...»

«When Disability Isn’t “Just Right”: The Entrenchment of the Medical Model of Disability and the Goldilocks Dilemma BRADLEY A. AREHEART∗ INTRODUCTION: THE FAIRY TALE OF DISABILITY PROTECTION I. THE ONGOING ENTRENCHMENT OF THE MEDICAL MODEL OF DISABILITY. 185 A. The Medical and Social Models of Disability B. Publicly: The Medical Paradigm of Disability Reigns C. Judicially: The Goldilocks Dilemma II. RESTORING THE ADA: A RETURN TO THE SOCIAL MODEL OF DISABILITY. 225 A. The ADA...»

«CAREERS IN PUBLIC HEALTH AN INTRODUCTION FOR MASTER’S LEVEL STUDENTS Entering the professional workforce requires not only a good education, but also job search savvy! You will be competing for top jobs with top people. As with anything, to be successful you need a plan of action. The UAB School of Public Health Office of Career Services is committed to assisting you as you prepare for your career in public health. We will acquaint you with the wide variety of career possibilities through our...»

«PACKAGE LEAFLET Package leaflet: Information for the user Co-amoxiclav 250mg/125mg film-coated Tablets Co-amoxiclav 500mg/125mg film-coated Tablets (Amoxicillin/clavulanic acid) Read all of this leaflet carefully before you start taking this medicine because it contains important information for you Keep this leaflet. You may need to read it again.If you have any further questions, ask your doctor or pharmacist. This medicine has been prescribed for you. Do not pass it on to others. It may harm...»

«Healthy Hospital Food Initiative A survey and analysis of food served at hospitals by the Physicians Committee for Responsible Medicine and ADinfinitum, Inc. September 2005 Healthy food is almost as important to healing as competent medical care, and healthy eating habits play a critical role in preventing chronic diseases such as heart disease, diabetes, and some cancers. Are hospital eating establishments meeting the need for low-fat, low-cholesterol, immune-boosting foods that can aid in...»

<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.