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What is Erectile dysfunction?
Erectile dysfunction (ED) is the inability to achieve or maintain penile erection for sexual intercourse. It involves an integration of hormonal, neurological, psychological and vascular pathways. Thus, ED may result from a wide range of pathologies.
As reported in the Massachusetts Male Aging Study, the prevalence of ED is of 52% in men aged 40-70 years. International studies report an increase of 10% in the prevalence of ED between 2001 and 2002. ED affects quality of life (QoL) in an adverse way. Many studies demonstrate men with ED report higher levels of loss productivity at work and poorer health-related QoL. ED has an influence on health-related QoL because of its association with depression and anxiety.
There is an increasing need for researching the impact of ED on the productivity of men in the world context. A consistent and robust approach is required in order to understand the impact on ED worldly.
Erectile dysfunction, productivity and absenteeism
Goldstein and colleagues conducted a study with the aim to evaluate work productivity among men with ED from eight different countries: Brazil, China, France, Germany, Italy, Spain, United Kingdom (UK) and the United States (US). The study also looked at health-related QoL in each country and globally.
The study included men who self-reported ED as a difficulty of achieving and maintain erection in the past 6 months. Erection difficulty was rated on a scale from 1 to 5, with score 2 or higher were classified as ED. Sociodemographic data and general health data was collected from all participants. A multipurpose generic health status questionnaire was used to determine the health-related QoL.
As compared to men without ED, men with ED were more likely to smoke, be obese, drink alcohol and not exercise. Moreover, men with ED were more likely to have comorbidities such hypertension, diabetes and depression. All of these factors are also collaterally related to performance at work.
In term of work productivity and absenteeism, men with ED reported higher levels of absenteeism (18.9% as compared to 13.9 % of men without ED). Overall work productivity impairment in men with ED was the highest in the UK. Moreover, scores of the health-related QoL questionnaire were lower in men with ED. The results from this study are not only consistent with previous findings but also add up to existing literature a new, more international perspective on the severity of ED and the way it impacts men’s life.
Low testosterone levels, which may affect middle-aged men, may explain the results in this study. However, ED is not only related to aging. Hypertension, diabetes, obesity, and an unhealthy lifestyle are associated with ED development. These same risk factors are associated with cardiovascular disease, and men with ED are more likely to have cardiovascular disease.
Other associations
Studies have shown a high association between ED and cardiovascular diseases such as myocardial infarction, stroke, and arteriosclerosis. A longitudinal cohort study found that ED can be a risk factor for developing a cardiovascular disease. Participants were followed up for 16 years and the incidence of cardiovascular diseases was higher in men with moderate-severe ED than in men with none-minimal ED, 17.9 % and12.5 % respectively. Araujo et al, found that there in an increased risk of all-cause mortality in men with ED and increase prevalence of cardiovascular disease-related death in men with moderate-severe ED as compared to men with none-minimal ED.
Conclusion
Despite the development of items such as IIEF and the MMAS-derived questionnaire there is a common use of non-validated assessment tools for ED. The prevalence of ED is high globally, and its impact on men’s quality of life, productivity at work and general health requires attention. ED does not simply represent a consequence of an unhealthy lifestyle and aging but also a symptom of a wider pathological spectrum including cardiovascular disease. Early detection of ED can benefit patients when cardiovascular risk factors are assessed and interventions are used to modify risk.
ED represents not only an economic burden demonstrated with a loss of productivity at work but also a health-related concern, on a global scale. Due to the sensitive nature of the topic, it is recommended that a screening is completed by physicians regularly as such information is rarely given away by the patients themselves. Results from current studies suggest the utilization of better treatment and appropriate management of men with ED, as the adverse consequences of ED are a significant concern for both patients and employers.
References
Further Reading
Association of genetically proxied PDE5 inhibition with measures of fertility, sexual behavior, and wellbeing