Prevalence and Correlates of Erectile Dysfunction (ED) and Treatment Seeking for ED in Asian Men: The Asian Men's Attitudes to Life Events and Sexuality (MALES) Study
Hui-Meng Tan MBBS (Mal), FRCS (Edin), FRCPS (Glasg), FAMM (Malaysia)
Subang Jaya Medical Center, Selangor, Malaysia;
Search for more papers by this authorWah Yun Low BA (Hons), MSc, PhD
University of Malaya, Kuala Lumpur, Malaysia;
Search for more papers by this authorChirk Jenn Ng MBBS (Singapore), Masters of Medicine (Family Medicine, Singapore)
University of Malaya, Kuala Lumpur, Malaysia;
Search for more papers by this authorKuang-Kuo Chen MD, PhD
Taipei Veterans General Hospital, Taipei, Taiwan;
Search for more papers by this authorKen Marumo MD
Ichikawa General Hospital, Ichikawa, Chiba, Japan;
Search for more papers by this authorSung Won Lee MD
Sungkyunkwan University School of Medicine, Seoul, Korea;
Search for more papers by this authorWilliam Fisher PhD
University of Western Ontario, London, Ontario, Canada;
Search for more papers by this authorHui-Meng Tan MBBS (Mal), FRCS (Edin), FRCPS (Glasg), FAMM (Malaysia)
Subang Jaya Medical Center, Selangor, Malaysia;
Search for more papers by this authorWah Yun Low BA (Hons), MSc, PhD
University of Malaya, Kuala Lumpur, Malaysia;
Search for more papers by this authorChirk Jenn Ng MBBS (Singapore), Masters of Medicine (Family Medicine, Singapore)
University of Malaya, Kuala Lumpur, Malaysia;
Search for more papers by this authorKuang-Kuo Chen MD, PhD
Taipei Veterans General Hospital, Taipei, Taiwan;
Search for more papers by this authorKen Marumo MD
Ichikawa General Hospital, Ichikawa, Chiba, Japan;
Search for more papers by this authorSung Won Lee MD
Sungkyunkwan University School of Medicine, Seoul, Korea;
Search for more papers by this authorWilliam Fisher PhD
University of Western Ontario, London, Ontario, Canada;
Search for more papers by this authorABSTRACT
Introduction. There have been limited multiregional studies in Asia examining the parameters of men's general and sexual health and quality of life in the general population vs. those in clinical cohorts of patients with erectile dysfunction (ED).
Aims. The aims of the Asian Men's Attitudes to Life Events and Sexuality (Asian MALES) study were to investigate the prevalence of ED, associated health conditions, and ED treatment-seeking patterns in the general male population in five regions of Asia (China, Japan, Korea, Malaysia, and Taiwan).
Main Outcome Measure. Standardized questionnaire previously used in a similar multiregional study and modified to ensure culturally appropriate content for Asia.
Methods. Phase I of the study involved 10,934 adult men, aged 20–75 years, who were interviewed using the standardized questionnaire. Phase II of the study involved men with self-reported ED recruited from Phase I and via physician referral, invitations in general practitioner offices, and street interception (total Phase II sample, N = 1,209).
Results. The overall prevalence of self-reported ED in the Phase I study population was 6.4%. ED prevalence varied by region and significantly increased with age (P < 0.01). Men with ED reported significantly greater rates of comorbid illness (P < 0.0001) and a reduced quality of life (P = 0.0001), compared with men without ED. Phase II of the study revealed that fewer than half of men with self-reported ED had sought treatment for their problem. Men were more likely to seek help for erection difficulties from Western doctors than from traditional medicine practitioners (P = 0.0001). A man's partner/spouse was the most common influencer of treatment seeking in all regions except Malaysia.
Conclusion. The findings confirm those of existing research on ED in both Asian and non-Asian males: ED is a prevalent condition; the prevalence of ED increases with age and is strongly associated with comorbid conditions; and the majority of men have never sought treatment for their condition. This study highlights a substantial need for the evaluation and treatment of ED in Asian men. Tan H-M, Low WY, NG CJ, Chen KK, Sugita M, Ishii N, Marumo K, Lee SW, Fisher W, and Sand M. Prevalence and correlates of erectile dysfunction (ED) and treatment seeking for ED in Asian men: the Asian men's attitudes to life events and sexuality (MALES) study. J Sex Med 2007;4:1582–1592.
References
- 1 Shabbir M, Mikhailidis DM, Morgan RJ. Erectile dysfunction: An underdiagnosed condition associated with multiple risk factors. Curr Med Res Opin 2004; 20: 603–6.
- 2 Latini DM, Penson DF, Wallace KL, Lubeck DP, Lue TF. Longitudinal differences in psychological outcomes for men with erectile dysfunction: Results from ExCEED. J Sex Med 2006; 3: 1068–76.
- 3 Latini DM, Penson DF, Wallace KL, Lubeck DP, Lue TF. Clinical and psychosocial characteristics of men with erectile dysfunction: Baseline data from ExCEED. J Sex Med 2006; 3: 1059–67.
- 4 Sugimori H, Yoshida K, Tanaka T, Baba K, Nishida T, Nakazawa R, Iwamoto T. Relationships between erectile dysfunction, depression, and anxiety in Japanese subjects. J Sex Med 2005; 2: 390–6.
- 5 Mallis D, Moisidis K, Kirana PS, Papaharitou S, Simos G, Hatzichristou D. Moderate and severe erectile dysfunction equally affects life satisfaction. J Sex Med 2006; 3: 442–9.
- 6 De Boer BJ, Bots ML, Nijeholt AA, Moors JP, Verheij TJ. The prevalence of bother, acceptance, and need for help in men with erectile dysfunction. J Sex Med 2005; 2: 445–50.
- 7 Sadovsky R, Nusbaum M. Sexual health inquiry and support is a primary care priority. J Sex Med 2006; 3: 3–11.
- 8 Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I. Sexual experience of female partners of men with erectile dysfunction: The female experience of men's attitudes to life events and sexuality (FEMALES) study. J Sex Med 2005; 2: 675–84.
- 9 Goldstein I, Fisher WA, Sand M, Rosen RC, Mollen M, Brock G, Karlin G, Pommerville P, Bangerter K, Bandel TJ; for the Vardenafil Study Group. Women's sexual function improves when partners are administered vardenafil for erectile dysfunction: A prospective, randomized, double-blind, placebo-controlled trial. J Sex Med 2005; 2: 819–32.
- 10 Dorey G. Partners' perspective of erectile dysfunction: Literature review. Br J Nurs 2001; 10: 187–95.
- 11 Fisher WA, Rosen RC, Mollen M, Brock G, Karlin G, Pommerville P, Goldstein I, Bangerter K, Bandel TJ, Derogatis LR, Sand M; for the Vardenafil Study Group. Improving the sexual quality of life of couples affected by erectile dysfunction: A double-blind, randomized, placebo-controlled trial of vardenafil. J Sex Med 2005; 2: 699–708.
- 12 Chevret M, Jaudinot E, Sullivan K, Marrel A, De Gendre AS. Impact of erectile dysfunction (ED) on sexual life of female partners: Assessment with the Index of Sexual Life (ISL) questionnaire. J Sex Marital Ther 2004; 30: 157–72.
- 13 Akkus E, Kadioglu A, Esen A, Doran S, Ergen A, Anafarta K, Hattat H. Prevalence and correlates of erectile dysfunction in Turkey: A population-based study. Eur Urol 2002; 41: 298–304.
- 14 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: 305–11.
- 15 Chew KK, Earle CM, Stuckey BG, Jamrozik K, Keogh EJ. Erectile dysfunction in general medicine practice: Prevalence and clinical correlates. Int J Impot Res 2000; 12: 41–5.
- 16 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.
- 17 Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. JAMA 1999; 281: 537–44.
- 18 Mak R, De Backer G, Kornitzer M, De Meyer JM. Prevalence and correlates of erectile dysfunction in a population-based study in Belgium. Eur Urol 2002; 41: 132–8.
- 19 Marumo K, Nakashima J, Murai M. Age-related prevalence of erectile dysfunction in Japan: Assessment by the International Index of Erectile Function. Int J Urol 2001; 8: 53–9.
- 20 Pinnock CB, Stapleton AM, Marshall VR. Erectile dysfunction in the community: A prevalence study. Med J Aust 1999; 171: 353–7.
- 21 El-Sakka AI. Lower urinary tract symptoms in patients with erectile dysfunction: Analysis of risk factors. J Sex Med 2006; 3: 144–9.
- 22 Costabile RA, Steers WD. How can we best characterize the relationship between erectile dysfunction and benign prostatic hyperplasia? J Sex Med 2006; 3: 676–81.
- 23 Mulhall J, Teloken P, Brock G, Kim E. Obesity, dyslipidemias and erectile dysfunction: A report of a subcommittee of the sexual medicine society of North America. J Sex Med 2006; 3: 778–86.
- 24 Bansal TC, Guay AT, Jacobson J, Woods BO, Nesto RW. Incidence of metabolic syndrome and insulin resistance in a population with organic erectile dysfunction. J Sex Med 2005; 2: 96–103.
- 25 El-Sakka AI, Hassoba HM, Sayed HM, Tayeb KA. Pattern of endocrinal changes in patients with sexual dysfunction. J Sex Med 2005; 2: 551–8.
- 26 Heruti R, Shochat T, Tekes-Manova D, Ashkenazi I, Justo D. Association between erectile dysfunction and sleep disorders measured by self-assessment questionnaires in adult men. J Sex Med 2005; 2: 543–50.
- 27 Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, McKinlay JB. Erectile dysfunction and coronary risk factors: Prospective results from the Massachusetts male aging study. Prev Med 2000; 30: 328–38.
- 28 Aytac IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. Br J Urol Int 1999; 84: 50–6.
- 29 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: 1055–65.
- 30 Nicolosi A, Glasser DB, Kim SC, Marumo K, Laumann EO. Sexual behaviour and dysfunction and help-seeking patterns in adults aged 40–80 years in the urban population of Asian countries. BJU Int 2005; 95: 609–14.
- 31 Haro JM, Beardsworth A, Casariego J, Gavart S, Hatzichristou D, Martin-Morales A, Schmitt H, Mirone V, Needs N, Riley A, Varanese L, Von Keitz A, Kontodimas X. Treatment-seeking behavior of erectile dysfunction patients in Europe: Results of the erectile dysfunction observational study. J Sex Med 2006; 3: 530–40.
- 32 Fisher WA, Rosen RC, Eardley I, Niederberger C, Nadel A, Kaufman J, Sand M. The multinational Men's Attitudes to Life Events and Sexuality (MALES) Study Phase II: Understanding PDE5 inhibitor treatment seeking patterns, among men with erectile dysfunction. J Sex Med 2004; 1: 150–60.
- 33 Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M. 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.
- 34 Chen KK, Chiang HS, Jiann BP, Lin JS, Liu WJ, Wu CJ, Hsieh JT, Wang CJ, Hwang TI, Lee SS. Prevalence of erectile dysfunction and impacts on sexual activity and self-reported intercourse satisfaction in men older than 40 years in Taiwan. Int J Impot Res 2004; 16: 249–55.
- 35 Bai Q, Xu QQ, Jiang H, Zhang WL, Wang XH, Zhu JC. Prevalence and risk factors of erectile dysfunction in three cities of China: A community-based study. Asian J Androl 2004; 6: 343–8.
- 36 Cho BL, Kim YS, Choi YS, Hong MH, Seo HG, Lee SY, Shin HC, Kim CH, Moon YS, Cha HS, Kim BS. Prevalence and risk factors for erectile dysfunction in primary care: Results of a Korean study. Int J Impot Res 2003; 15: 323–8.
- 37 Nicolosi A, Moreira ED Jr, M Shirai, MI Bin Mohd Tambi, DB. Glasser Epidemiology of erectile dysfunction in four countries: Cross-national study of the prevalence and correlates of erectile dysfunction. Urology 2003; 61: 201–6.
- 38 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.
- 39 Ng CJ, Low WY, Tan NC, Choo WY. The role of general practitioners in the management of erectile dysfunction—a qualitative study. Int J Impot Res 2004; 16: 60–3.
- 40 Moreira ED Jr, SC Kim, D Glasser, C. Gingell Sexual activity, prevalence of sexual problems, and associated help-seeking patterns in men and women aged 40–80 years in Korea: Data from the Global Study of Sexual Attitudes and Behaviors (GSSAB). J Sex Med 2006; 3: 201–11.
- 41 Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T. Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 2005; 17: 39–57.
- 42 Sanchez-Cruz JJ, Cabrera-Leon A, Martin-Morales A, Fernandez A, Burgos R, Rejas J. Male erectile dysfunction and health-related quality of life. Eur Urol 2003; 44: 245–53.
- 43 Rubio-Aurioles E, Porst H, Eardley I, Goldstein I. Comparing vardenafil and sildenafil in the treatment of men with erectile dysfunction and risk factors for cardiovascular disease: A randomized, double-blind, pooled crossover study. J Sex Med 2006; 3: 1037–49.
- 44 Edwards D, Hackett G, Collins O, Curram J. Vardenafil improves sexual function and treatment satisfaction in couples affected by erectile dysfunction (ED): A randomized, double-blind, placebo-controlled trial in PDE5 inhibitor-naive men with ED and their partners. J Sex Med 2006; 3: 1028–36.
- 45 McMahon C, Lording D, Stuckey B, Tan V, Gillman M, White W, Di Natale S, Bramwell P. Vardenafil improved erectile function in a “real-life” broad population study of men with moderate to severe erectile dysfunction in Australia and New Zealand. J Sex Med 2006; 3: 892–900.
- 46 Ziegler D, Merfort F, Van Ahlen H, Yassin A, Reblin T, Neureither M. Efficacy and safety of flexible-dose vardenafil in men with type 1 diabetes and erectile dysfunction. J Sex Med 2006; 3: 883–91.
- 47 Althof SE, O'Leary MP, Cappelleri JC, Hvidsten K, Stecher VJ, Glina S, King R, Siegel RL. Sildenafil citrate improves self-esteem, confidence, and relationships in men with erectile dysfunction: Results from an international, multi-center, double-blind, placebo-controlled trial. J Sex Med 2006; 3: 521–9.
- 48 Lewis RW, Sadovsky R, Eardley I, O'Leary M, Seftel A, Wang WC, Shen W, Walker DJ, Wong DG, Ahuja S. The efficacy of tadalafil in clinical populations. J Sex Med 2005; 2: 517–31.