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What are the factors associated with discontinuation of erectile dysfunction treatment?

A new review by City academics and colleagues at East London NHS Foundation Trust looks at which factors influence men's use of treatments for erectile dysfunction, including their beliefs about treatment.

by Shamim Quadir (Senior Communications Officer)

A new review by academics from City, University of London and East London NHS Foundation Trust has investigated which factors may be associated with men ending treatment for erectile dysfunction. The most influential factors reported were treatment ineffectiveness, side effects, the quality of one’s intimate relationship with another and cost of treatment.

The review also highlights the importance of men’s beliefs about erectile dysfunction and its treatment, and suggests that these beliefs are potentially modifiable.

Erectile dysfunction?

Erectile dysfunction, the persistent inability to develop or maintain a penile erection during sexual activity, is thought to affect up to 10% of men under 40 and 70% of men over 70 years of age. Treatment includes medications delivered orally. Where these fail or are contraindicated, treatments are available which are administered via injection, or via suppositories. Penile implants are also available where all other treatments have failed.

What did the researchers do?

Reviewing data on 14,371 men from 50 previous studies, the researchers assessed the rates of discontinuation of erectile dysfunction treatment and the factors associated with it.

What did the researchers find?

Results suggest that discontinuation rates varied across treatments and that adherence to erectile dysfunction treatment could be improved.

The authors found that 12% of men taking oral medication, 15% of men taking injected medication and 32% of men taking suppositories reported inadequate or inconsistent erectile responses as their reason for discontinuing treatment.

Almost 3% of men taking oral medication, 8% of men injecting medication and 15% of men taking suppositories stated that they stopped treatment due to side effects including headaches, Peyronie’s disease (a build-up of scar tissue in the penis) or urethral pain.

There were also a number of factors reported relating to the quality of sexual relationships. Most commonly:

Almost 6% of men taking oral medication reported stopping oral medication treatment due their partner’s perceived lack of interest in the sexual relationship,

Almost 6% of men described not being emotionally ready for sexual activity and 4% discontinued treatment because of conflict within their relationship.

Paul Williams, lead author, and PhD candidate at the School of Health Sciences at City, University of London, said:

Men’s perceptions of their sexual relationships and their emotional readiness for sexual activity are important when considering the most appropriate treatment for a man and his partner. Perceived ineffectiveness of treatment has a subjective element based on, for example, treatment expectations prior to treatment. We found that men who reported treatment side effects to a healthcare professional were more likely to continue with treatment. Exploring any misconceptions patients may have in relation to their treatment could potentially be beneficial to increasing treatment utilisation and therefore something that could help health care professionals when faced with treatment failure.

Limitations and further study

The authors caution that due to an under-reporting of data on duration and severity of erectile dysfunction and relationship status in the majority of the included studies, the influence of these factors on treatment use could not be fully explored in this review.

They suggest that further research should explore how beliefs affecting treatment adherence can be addressed during treatment to improve the quality of life of men and their partners. Meaning future research would benefit from using psychological theory to explore barriers and enablers to treatment utilisation, as well as from measuring how treatment is utilised by patients and health practitioners. Taking such steps may lead to interventions aimed at improving treatment utilisation in this patient population, according to the authors.

The review is published in the journal, IJIR: Your Sexual Medicine Journal.

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