A new study published in the journal IJIR: Your Sexual Medicine Journal in March 2020 reports the most common reasons why men stop their treatment for erectile dysfunction. The most common reasons were that the treatment did not work, cost too much, or had unacceptable side effects. Loss of interest in sexual relationships was another primary reason.
In addition, the study also shows how important it is to educate men about the condition, how it can be treated, and the possibility of changing their beliefs to help them make use of the treatment. A good understanding of what factors modify treatment utilization decisions is necessary to help patients make better choices.
Researchers say, "erectile dysfunction can have a negative effect on men's quality of life. However, this can potentially be improved with successful treatment for the condition. The findings from our research indicate that rates of discontinuation for treatment are high. Understanding the reasons for discontinuation of treatment is essential with regards to improving treatment use and, subsequently, quality of life in this patient population."
What is erectile dysfunction?
Erectile dysfunction (ED) is the persistent inability to have or sustain an erection during sexual activity. It occurs in up to a tenth of men under 49 years, increasing to one in five between 60 and 69 years, but in over 70% of men past the age of 70.
ED can adversely affect self-confidence, cause depression, and reduce the quality of life.
Most men with ED are treated with oral phosphodiesterase type 5 inhibitors, but if this does not work, injectable drugs and urethral suppositories are sometimes used. As a last resort, penile implants are used.
The researchers looked at the data from 50 studies, covering over 14,370 men. They asked about how they found the treatment, and what factors were linked to discontinuation of treatment.
The study found that the rates of discontinuation due to unsatisfactory response (in terms of hardness and duration of erection) varied with the type of treatment, but occurred in about a third of patients across all studies. For instance, with men on tablets, the rate was about 12%, but with injectables, about 15%. On the other hand, the use of suppositories was associated with inconsistent or poor efficacy resulting in discontinuation in about a third of patients.
Discontinuation as a result of adverse effects such as headaches, Peyronie's disease or priapism, and urethral pain was reported by less than 3% of men on tablets, 8% of men on injectables and 15% of men using suppositories.
A small percentage of men also reported that factors dealing with the quality of sexual relationship had to do with their discontinuation of the treatment. This factor was cited by about 7% of men on pills, 9% on injectables, 9% taking suppositories, and 7% of men with penile implants.
About 6% of men on pills said they stopped because they felt their partner was no longer interested in the sexual relationship, about 6% because they were not ready emotionally to invest in the relationship, and 4% because of conflict with their partners. Thus, there is a small but significant contribution by the quality of the sexual relationship on the continuation of treatment.
Said Williams, "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."
Despite the safety and effectiveness of PDE5Is, many men stopped them because of not wanting to tie down sexual activity to their medication use, the lag time until response, and the cost of treatment.
Other misconceptions had to do with the fear of drug dependency, heart disease as a result of the medications. At the same time, embarrassment or inconvenience while buying the medication was also a factor for some people. If the medication was not on hand, such as if the patient forgot to buy it, the resulting embarrassment was also severe.
The limitations of the study were lack of data on the duration of ED, its severity, and the quality of the relationship, in many studies. The outcome was difficulty in evaluating how these factors contributed to treatment duration.
Surprisingly only 12/50 studies looked at psychological or cognitive factors leading to the cessation of treatment, despite the psychogenic origin of ED in almost all cases. The treatment cost was not explored thoroughly.
The researchers suggest that future work should explore the role of beliefs about ED and its treatment because this could play a pivotal role in the decision to continue or stop therapy.
For instance, patient expectations about treatment effectiveness play a part in awakening perceptions of treatment failure. Men who got back to their doctors about the side effects of treatment were more likely to continue the treatment, the study found. This suggests that finding out what thoughts the patient has about his treatment, and trying to correct any misconceptions therein, may help to promote the use of this treatment. This is a crucial way to help doctors avoid treatment failure.
Psychological theory could be a valuable tool, suggest the authors, to look at what hinders men with ED from coming forward to exploit current treatment modalities. It could also spot the factors which promote or enhance treatment utilization. Thirdly, it could help assess how this treatment is being viewed and used by the end-users. Such evaluation procedures could help this group of patients to use available ED treatments more effectively.
Williams, P. et al. (2020). Men's beliefs about treatment for erectile dysfunction—what influences treatment use? A systematic review. IJIR: Your Sexual Medicine Journal, https://doi.org/10.1038/s41443-020-0249-1.