Sexual Satisfaction among Patients with Erectile Dysfunction Treated with Counseling, Sildenafil, or Both
Carmita H.N. Abdo
Sexuality Project—Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil;
Search for more papers by this authorJoão Afif-Abdo
Sexuality Project—Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil;
Search for more papers by this authorFabio Otani
Sexuality Project—Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil;
Search for more papers by this authorAlbangela Ceschin Machado
Sexuality Project—Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil;
Search for more papers by this authorCarmita H.N. Abdo
Sexuality Project—Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil;
Search for more papers by this authorJoão Afif-Abdo
Sexuality Project—Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil;
Search for more papers by this authorFabio Otani
Sexuality Project—Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil;
Search for more papers by this authorAlbangela Ceschin Machado
Sexuality Project—Department and Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil;
Search for more papers by this authorABSTRACT
Introduction. Sexual satisfaction is linked to life satisfaction, and erectile dysfunction (ED) may lead to an impaired quality of life (QOL).
Aim. Our goal was to evaluate the QOL among Brazilian patients with ED, before and after three kinds of treatment.
Methods. Men aged 25–55 years, with a diagnosis of psychogenic or mixed ED, according to the Classification of Mental and Behavioral Disorders of the International Classification of Diseases, 10th edition, and the Standard Practice in Sexual Medicine, were randomly assigned to three treatment groups: counseling, sildenafil, and sildenafil plus counseling. At baseline each group had 40 patients. Sildenafil was provided in 50 mg that could be adjusted to 100 mg. The patients could initially take one to two tablets per week and the entire treatment lasted for 3 months. Counseling was provided in group sessions that took place once a week. They were evaluated at baseline and after 3 months of treatment with the Male Sexual Quotient (MSQ) and the Sexual Health Inventory for Men (SHIM).
Main Outcome Measures. The correlation between the patients' MSQ score and scores on the SHIM.
Results. One hundred seventeen patients were enrolled. The three groups were similar according to age, marital status, mean time of ED, and ED severity and etiology. At baseline, MSQ and SHIM total scores were not different among the three groups. MSQ scores increased from 41.2 ± 15.3, 38.7 ± 18.0, and 46.8 ± 17.0 to 48.5 ± 15.3, 63.8 ± 21.6, and 70.0 ± 17.3 after counseling, sildenafil, and sildenafil plus counseling, respectively (P < 0.05). SHIM scores also increased significantly (9.6 ± 4.1, 9.7 ± 4.1, and 10.2 ± 3.9 to 12.1 ± 3.9, 16.7 ± 5.6, and 17.7 ± 4.5 after counseling, sildenafil, and sildenafil plus counseling, respectively) (P < 0.05). There were no serious adverse events related to sildenafil, and no patient was withdrawn from the study because of an adverse event.
Conclusions. The three treatments were significantly efficient, and the best treatment was sildenafil associated with counseling. Abdo CHN, Afif-Abdo J, Otani F, and Machado AC. Sexual satisfaction among patients with erectile dysfunction treated with counseling, sildenafil, or both. J Sex Med 2008;5:1720–1726.
References
- 1 NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83–90.
- 2 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: 54–61.
- 3 Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M; Men's Attitudes to Live Events and Sexuality (MALES) Study. The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin 2004; 20: 607–17.
- 4 Prins J, Blanker MH, Bohnen AM, Thomas S, Bosch JL. Prevalence of erectile dysfunction: A systematic review of population-based studies. Int J Impot Res 2002; 14: 422–32.
- 5 Moreira ED Jr, Abdo CH, Torres EB, Lobo CF, Fittipaldi JA. Prevalence and correlates of erectile dysfunction: Results of the Brazilian study of sexual behavior. Urology 2001; 58: 583–8.
- 6 Abdo CHN, Oliveira Jr WM, Moreira Jr ED, Fittipaldi JAS. Perfil sexual da população brasileira: Resultado do Estudo do Comportamento Sexual (ECOS) do Brasileiro [Sexual profile of the Brazilian population: Results from the Brazilian Study of Sexual Behavior (BSSB)]. Rev Bras Med 2002; 59: 250–7.
- 7 Anderson KE, Wagner G. Physiology of penile erection. Physiol Rev 1995; 75: 191–236.
- 8 Torrance GW, Keresteci MA, Casey R, Ryan NC, Tarride JE. Measuring quality of life: The development and initial validation of the patient-reported erectile function assessment instrument. Int J Technol Assess Health Care 2006; 22: 372–8.
- 9 Rosen RC. Quality of life assessment in sexual dysfunction trials. Int J Impot Res 1998; 10(2 suppl): S21–3; discussion S24–6.
- 10 Tomlinson J, Wright D. Impact of erectile dysfunction and its subsequent treatment with sildenafil: Qualitative study. BMJ 2004; 328: 1037.
- 11 Jonler M, Moon T, Brannan W, Stone NN, Heisey D, Bruskwitz RC. The effect of age, ethnicity and geographical location on impotence and quality of life. Br J Urol 1995; 75: 651–5.
- 12 Althof SE. Quality of life and erectile dysfunction. Urology 2002; 59: 803–10.
- 13 McCabe M, Matic H. Severity of ED relationship to treatment-seeking and satisfaction with treatment using PDE5 inhibitors. J Sex Med 2007; 4: 145–51.
- 14 Rosen RC, Seidman SN, Menza MA, Shabsigh R, Roose SP, Tseng LJ, Orazem J, Siegel RL. Quality of life, mood, and sexual function: A path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms. Int J Impot Res 2004; 16: 334–40.
- 15 Tavallaii SA, Fathi-Ashtiani A, Nasiri M, Assari S, Maleki P, Einollahi B. Correlation between sexual function and postrenal transplant quality of life: Does gender matter? J Sex Med 2007; 4: 1610–8.
- 16 Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group. N Engl J Med 1998; 338: 1397–404.
- 17 Moore RA, Edwards JE, McQuay HJ. Sildenafil (Viagra) for male erectile dysfunction: A meta-analysis of clinical trial reports. BMC Urol 2002; 2: 6.
- 18 Glina S, Bertero E, Claro J, Damiao R, Faria G, Fregonesi A, Jaspersen J, Mendoza A, Mattos D Jr, Rocha LC, Sotomayor M, Teloken C, Ureta S, Zonana E, Ugarte F. Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in Brazilian and Mexican men. Int J Impot Res 2002; 14(2 suppl): S27–32.
- 19 Carrier S, Brock G, Casey R, Tarride JE, Elliott S, Dugré H, Rousseau C, D'Angelo P, Defoy I. Treatment satisfaction with sildenafil in a Canadian real-life setting. A 6-month prospective observational study of primary care practices. J Sex Med 2007; 4: 1414–21.
- 20 Giuliano F, Pena BM, Mishra A, Smith MD. Efficacy results and quality of life measures in men receiving sildenafil citrate for the treatment of erectile dysfunction. Qual Life Res 2001; 10: 359–69.
- 21 Teloken P, Valenzuela R, Parker M, Mulhall J. The correlation between erectile function and patient satisfaction. J Sex Med 2007; 4: 472–6.
- 22 Brotons FB, Campos JC, Gonzalez-Correales R, Martin-Morales A, Moncada I, Pomerol JM. Core document on erectile dysfunction: Key aspects in the care of a patient with erectile dysfunction. Int J Impot Res 2004; 16(2 suppl): S26–39.
- 23 Banner LL, Anderson RU. Integrated sildenafil and cognitive-behavior sex therapy for psychogenic erectile dysfunction: A pilot study. J Sex Med 2007; 4: 1117–25.
- 24 World Health Organization. Classification of mental and behavioral disorders. Clinical descriptions and diagnostic guidelines. 10th edition (ICD-10). Geneva: World Health Organization; 1992.
- 25
Porst H,
Buvat J.
Standard practice in sexual medicine. Malden, MA: Blackwell Pub; 2006.
10.1002/9780470755235 Google Scholar
- 26 Abdo CHN. The male sexual quotient: A brief, self-administered questionnaire to assess male sexual satisfaction. J Sex Med 2007; 4: 382–9.
- 27 Abdo CHN. Elaboração e validação do quociente sexual—Versão masculina, uma escala para avaliar a função sexual do homem [Development and validation of male sexual quotient—A questionnaire to assess male sexual satisfaction]. Rev Bras Med 2006; 63: 42–6.
- 28 Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11: 319–26.
- 29 Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–30.
- 30 Fugl-Meyer AR, Lodnert G, Branholm IB, Fugl-Meyer KS. On life satisfaction in male erectile dysfunction. Int J Impot Res 1997; 9: 141–8.
- 31 Porst H, Gilbert C, Collins S, Huang X, Symonds T, Stecher V, Hvidsten K. Development and validation of the quality of erection questionnaire. J Sex Med 2007; 4: 372–81.
- 32 Ramanathan R, Mulhall J, Rao S, Leung R, Martinez Salamanca JI, Mandhani A, Tewari A. Predictive correlation between the International Index of Erectile Function (IIEF) and Sexual Health Inventory for Men (SHIM): Implications for calculating a derived SHIM for clinical use. J Sex Med 2007; 4: 1336–44.
- 33 Wetterauer U, Grohmann W, Albrecht S. Patient satisfaction with Viagra (sildenafil citrate) for erectile dysfunction (ED) after switching from other treatment options. J Sex Med 2005; 2(1 suppl): 64–5.
- 34 Olsson AM, Speakman MJ, Dinsmore WW, Giuliano F, Gingell C, Maytom M, Smith MD, Osterloh I; Sidenafil Multicentre Study Group. Sildenafil citrate (Viagra) is effective and well tolerated for treating erectile dysfunction of psychogenic or mixed aetiology. Int J Clin Pract 2000; 54: 561–6.
- 35 Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. JAMA 1999; 281: 537–44.
- 36 Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction: Cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med 1998; 60: 458–65.
- 37 Symonds T, Roblin D, Hart K, Althof S. How does premature ejaculation impact a man's life? J Sex Marital Ther 2003; 29: 361–70.
- 38 Lewis R, Bennett CJ, Borkon WD, Althof SE, Stecher VJ, Siegel RL. Patient and partner satisfaction with Viagra (sildenafil citrate) treatment as determined by the Erectile Dysfunction Inventory of Treatment Satisfaction Questionnaire. Urology 2001; 57: 960–5.
- 39 Paige NM, Hays RD, Litwin MS, Rajfer J, Shapiro MF. Improvement in emotional well-being and relationships of users of sildenafil. J Urol 2001; 166: 1774–8.
- 40 Cappelleri JC, Althof SE, Siegel RL, Shpilsky A, Bell SS, Duttagupta S. Development and validation of the Self-Esteem and Relationship (SEAR) questionnaire in erectile dysfunction. Int J Impot Res 2004; 16: 30–8.
- 41 Williams G, Abbou CC, Amar ET, Desvaux P, Flam TA, Lycklama a Nijeholt GA, Lynch SF, Morgan RJ, Muller SC, Porst H, Pryor JP, Ryan P, Witzsch UK, Hall MM, Place VA, Spivack AP, Todd LK, Gesundheit N. The effect of transurethral alprostadil on the quality of life of men with erectile dysfunction, and their partners. MUSE Study Group. Br J Urol 1998; 82: 847–54.
- 42 Muller MJ, Benkert O. Lower self-reported depression in patients with erectile dysfunction after treatment with sildenafil. J Affect Disord 2001; 66: 255–61.
- 43 Seidman SN, Roose SP, Menza MA, Shabsigh R, Rosen RC. Treatment of erectile dysfunction in men with depressive symptoms: Results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001; 158: 1623–30.
- 44 Smith LJ, Mulhall JP, Deveci S, Monaghan N, Reid MC. Sex after seventy: A pilot study of sexual function in older persons. J Sex Med 2007; 4: 1247–53.
- 45 Nelson CJ, Choi JM, Mulhall JP, Roth AJ. Determinants of sexual satisfaction in men with prostate cancer. J Sex Med 2007; 4: 1422–7.
- 46 Melnik T, Abdo CH. Psychogenic erectile dysfunction: Comparative study of three therapeutic approaches. J Sex Marital Ther 2005; 31: 243–55.
- 47 Garos S, Kluck A, Aronoff D. Prostate cancer patients and their partners: Differences in satisfaction indices and psychological variables. J Sex Med 2007; 4: 1394–403.
- 48 Taneja R. A rational combination pharmacotherapy in men with erectile dysfunction who initially failed to oral sildenafil citrate alone: A pilot study. J Sex Med 2007; 4: 1136–41.
- 49 Hundertmark J, Esterman A, Ben-Tovim D, Austin MA, Dougherty M. The South Australian couples sildenafil study: Double-blind, parallel-group randomized controlled study to examine the psychological and relationship consequences of sildenafil use in couples. J Sex Med 2007; 4: 1126–35.