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Prevalence of erectile dysfunction in primary care setting, Malaysia
American Journal of Men's Health
Abstract
Background: The objective of this study was to identify the prevalence and associated factors of erectile dysfunction (ED) among men who frequented public primary care clinics in an urban district in Malaysia. Methods: A total of 1331 men aged 40-76 years participated in this cross-sectional study. Information on demographic information, medical history and lifestyle factors were obtained through self administered questionnaire. ED was assessed using the International Index of Erectile Function (IIEF-5). Results: The participants' age ranged from 40-79 years with a mean of 54.7 (±8.3) years. The prevalence of ED was 69.5%. In terms of severity, 33.1% had mild, 26.6% moderate and 9.8% severe ED. The participants with increased age had reportedly higher prevalence of ED. The prevalence of ED increased from 49.7% of men in their 40s to 66.5%, 92.8% and 93.9% of men in their 50s, 60s and 70s respectively. The prevalence of moderate and severe ED also increased with age. The prevalence of severe ED was only 2.1% of men in their 40s and rose to 22.4% of men aged more than 60 years. The prevalence of ED among those with diabetics or heart disease was the highest (89.2%) followed by hypertensives (80.4%) and hypercholesterolaemia (78.9%). Men in their 50s (OR = 2.0) and 60s (OR = 13.5) had higher odds in ED. Conclusions: This study found that ED was common among men aged 40 years and above at the primary care setting. The prevalence and severity of ED increased with age.
... Erectile dysfunction (ED) is a global health problem that affects nearly half of men over the age of 40 years. [1][2][3][4] In Malaysia, more than two-thirds of men aged above 40 years have ED, [5] while the majority of elderly Malaysians aged above 65 years old had ED in 2014. [6] ED is known to be attributed to various pathological mechanisms such as vascular impairment, neurological, hormonal, and psychological components. ...
... The sample size was calculated using a single proportion formula based on the objective of the study. According to Ab Rahman et al., [5] the prevalence of ED among adult males aged 40-76 years old was 69.5%. Taking the alpha value of 0.05 with a CI of 95%, the minimum required sample was 304 patients. ...
... [33] Previous studies also showed a similar prevalence as in this study, with more than 70% of men with MetS having ED. [34,35] The prevalence of ED among MetS was not surprising to be higher compared to the general populations in Asian and Western studies. [1,3,5,[36][37][38][39] This study supports the strong pathogenicity of MetS in ED. [35,40] The relationship between MetS and ED was first described by Gündüz et al. in 2004, [41] and there were consistent findings in the literature that reported that MetS was strongly associated with ED. [34,35,[42][43][44] A meta-analysis revealed that patients with MetS had a 2.6-fold increased risk of having ED. [44] The reason for this is generally attributed to a constellation of interrelated cardiac risk factors consisting of insulin resistance, abdominal obesity, atherogenic dyslipidemia, and systemic inflammation that can cause ED. [45] MetS can result in endothelial dysfunction, which has been implicated in atherosclerosis leading to ED. In a study conducted by Thompson et al., [45] a strong association was indicated between elevated biomarkers of inflammation and endothelial dysfunction with increased odds of prediabetes, diabetes, and MetS among adults in China. ...
A BSTRACT
Background
Erectile dysfunction (ED) is an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between handgrip strength (HGS) and ED, especially among men with a high risk of CVD. This study aimed to determine the prevalence of ED among men aged ≥40 years with metabolic syndrome (MetS) and its association with HGS.
Materials and Methods
A cross-sectional study at an institutional primary care clinic in Malaysia was conducted between June 2021 and October 2021. HGS and erectile function were assessed using a hand dynamometer and International Index of Erectile Function (IIEF-5) questionnaire, respectively. Multiple logistic regression analyses were performed to determine the association between sociodemographics, clinical characteristics, and HGS with ED.
Results
A total of 334 participants were recruited. The prevalence of ED was 79% (95% confidence interval [CI]: 0.75-0.84). ED was associated with elderly aged ≥60 years (odds ratio [OR] 3.27, 95%CI: 1.60-6.69), low HGS (OR 15.34, 95%CI: 5.64-41.81) and high total cholesterol (OR 0.36, 95%CI: 0.16-0.78).
Conclusion
In conclusion, age above 60 years and those with low HGS are at higher risk of ED. Thus, robust screening of ED among men with MetS and improving muscle strength and physical fitness may be warranted.
... [1] The prevalence of ED was 69.5% among men attending a primary care setting in Malaysia. [2] The problem of ED is mainly linked to age, as shown in a Malaysian study that the prevalence of ED increased from 49.7% of men in their 40s to 66.5%, 92.8%, and 93.9% of men in their 50s, 60s, and 70s, respectively. [2] Men with ED are more likely to have coronary heart disease (CHD). ...
... [2] The problem of ED is mainly linked to age, as shown in a Malaysian study that the prevalence of ED increased from 49.7% of men in their 40s to 66.5%, 92.8%, and 93.9% of men in their 50s, 60s, and 70s, respectively. [2] Men with ED are more likely to have coronary heart disease (CHD). ED and CHD share many risk factors such as diabetes mellitus, hypertension, smoking, dyslipidemia, and aging. ...
... [5] In the present study, the prevalence of ED among those with diabetes or heart disease was the highest (89.2%) followed by hypertension (80.4%). [2] However, ED screening for diabetic men was not executed well in our primary care setting. Out of the total 7472 diabetic men who frequented public primary care clinics in the districts of Larut, Matang, and Selama, Taiping Perak, only 1371 (18.3%) were screened and 38 (2.8%) were diagnosed to have ED in 2017. ...
Background: Erectile dysfunction (ED) is a common health problem and has clinical importance. it is well documented that ED is associated
with coronary heart disease. However, the practice of ED screening is poor in primary care settings. Objectives: To assess primary health-care providers’
knowledge and attitude toward ED and to determine the confidence and barriers in the screening of ED. Materials and Methods: Across-sectional
study using self-administered questionnaires was conducted at 11 government health clinics in Taiping Perak in 2018 involving all health-care
providers who run the outpatient and noncommunicable disease unit. SPSS (version 25) statistical package was used to analyze the data.
Mann–Whitney U-test, Kruskal–Wallis test, and Chi-square test were employed. Results: Atotal of 77 primary health-care providers participated
in this study. The median age of the participants was 31 years (interquartile range 7). A total of 38 (49.4%) participants scored above the median
knowledge. Participants who were doctors, users of clinical practice guide in ED, confident in ED screening, and perceived adequate training scored
higher in knowledge (P ≤ 0.05). Smoking as a cause of ED (98.7%) recorded the highest percentage of correct responses, whereas the prevalence
of ED (18.2%) recorded the lowest. All participants perceived ED as an important health issue and felt that proper treatment is required. Only
16 (20.8%) participants had confidence in ED screening practice. Lack of training in ED screening and assessment was the barrier that significantly
affects the confidence of practice (P = 0.012). Conclusion: The knowledge on ED and confidence in its screening were unsatisfactory among
the primary health-care providers. Our work suggests the requirement to equip health-care professionals with adequate training on ED screening,
assessment, and management for early prevention of cardiovascular disease and improvement of men’s quality of life.
... According to National Institutes of Health (NIH) consensus panel, erectile dysfunction (ED) is defined as the inability of a man to obtain and/or maintain a penile erection that is sufficient for satisfactory sexual performance (NIH Consensus Conference, 1993;Shamloul, Ghanem, 2013). A recent study by Rahman showed that 69.5 % of Malaysians men with aged 40 to 79 years old reported had ED (Ab Rahman, Al-Sadat, Yun Low, 2011). Since it is not life threatening, men give less attention and left it untreated. ...
... Few epidemiology studies reported that the prevalence of erectile dysfunction varies according to age range, countries and ethnic groups. In Malaysia, Ab Rahman et al. (2011) and Fadzil et al. (2014) reported 69.5% and 62% of Malaysian aged 40 years and above have ED respectively and the incidence varies among the three main ethnic groups living in this country (Ab Rahman, Al-Sadat, Yun Low, 2011;Fadzil et al., 2014). ...
... Few epidemiology studies reported that the prevalence of erectile dysfunction varies according to age range, countries and ethnic groups. In Malaysia, Ab Rahman et al. (2011) and Fadzil et al. (2014) reported 69.5% and 62% of Malaysian aged 40 years and above have ED respectively and the incidence varies among the three main ethnic groups living in this country (Ab Rahman, Al-Sadat, Yun Low, 2011;Fadzil et al., 2014). ...
The incidence of erectile dysfunction (ED) is rising worldwide and its prevalence is one of the main health concerns that affect overall men well-being in Malaysia. The cluster of demographic, clinical and lifestyle factors may have contributed to the severity of ED and changes in biomarkers level; nevertheless these have not been studied extensively. This cross sectional study involved a total of 276 patients with 138 was diagnosed with ED. The demographic, clinical, lifestyle factors and severity of ED were assessed using a set of questionnaire and the International Index of Erectile Function (IIEF-5). Meanwhile, Total Testosterone (TT) and Asymmetric dimethylarginine (ADMA) levels were determined using the enzyme-linked immunosorbant assay (ELISA). Binary logistic regression test was used to demonstrate the predictors of severity of ED, TT and ADMA levels. Significant predictors for worsening of severity of ED are self-employed [10.55 (0.43 - 257.06), p=0.004], pensioner [8.07 (0.19 - 352.45), p=0.026], non-government employee [1.16 (0.05 - 26.26), p=0.04] and TT [0.41 (0.25 - 0.69), p=0.001]. Nevertheless, pensioner [0.08 (0.01 - 0.87), p=0.038] and unemployed [0.04 (0.01 - 0.42), p=0.007], were the predictors that may influence the changes of TT levels. On the other hand, academic qualification (secondary) [4.51 (0.48 - 42.83), p=0.014] and intensity of physical activities (< 1 hour/day) [2.61 (0.65 - 10.48), p=0.008] were the predictors which were more likely to influence the changes of ADMA levels in ED patients. TT and ADMA levels were influenced by demographic and lifestyle factors whilst severity of ED was predicted by demographic and clinical factors in Malaysian ED population. These predictors may provide new knowledge on risk factors of severity of ED and help in management of ED. Thus, the predictive models could serve as a primary guidance to physicians to ensure ED being managed and treated more effectively.
... In the US, Selvin [8] revealed a significant difference in the prevalence of ED according to age group. The survey Ab Rahman [9] in Malaysia on a middle-aged population 54.7 years found a prevalence of ED to 69.49% in men from 40 years and this rate increased with age. ...
... The investigations Selvin [8] revealed a significant association between ED and lower educational levels. In Malaysia, Ab Rahman [9] obtained opposite results; 65.5% of his patients had at least a high school education. ...
... However, Diao [12] and Diallo [5] had found more ED in the retired population, (63.8% and 62%) than in the working group (30.6% and 38%) respectively. Akkus [13]; Ab Rahman [9] had noted a positive correlation between joblessness (unemployment and/or retirement) and the prevalence of ED. ...
Introduction: The objective of our study was to analyze the clinical and epidemiologic aspects of erectile dysfunction in subjects with different comorbidities in Senegal. Patients and Methods: This was a retrospective study over a period of 2 years on patients who presented themselves for consultation for erectile dysfunction. The study was carried out in the regions of Dakar and Thies at the Ouakam geriatric center and the Saint Jean of god Hospital of Thies respectively. Results: We enrolled into the study 402 patients with erectile dysfunction. The average age of our patients was 47 ± 5 years. Patients aged more than 60 years were the most. The majority of our patients had less than secondary school level education, 211 in total representing 52.5% of the study population compared to 14.9% having post baccalaureate level. A large number of these patients had professional activities (53.3%), followed by retirees (29.6%). Polygamous patients were more in number (51.5%). In our study sample, we registered 120 active smokers (29.9%). A hundred and ten of our patients were sedentary for periods of 5 months to 22 years. The average length of time before seeking help for erectile dysfunction in our patients was 2.8 years. Severe erectile dysfunction was predominant in the smoking group (54.2%) compared to (9.9%) in the non-smoking group. We found a large proportion of severe and moderate erectile dysfunction (66.3%) and (31.7%) respectively in diabetic than non-diabetic patients. Severe erectile dysfunction was more in hypertensive and diabetics. Severe erectile dysfunction was more present in hypertensive plus smokers (83.9%) than in non-smoking hypertensive patients (68.6%). Severe ED was found more in hypertension and diabetic subjects. Conclusion: Erectile dysfunction is most frequently related on one side to socio-environmental factors, and to co-existing comorbidities on the other side.
... E rectile dysfunction (ED) is the most frequent male sexual dysfunction encountered worldwide, especially among men with type 2 diabetes. 1,2 The risk of developing ED is significantly associated with age, duration of type 2 diabetes, lower physical activity, microvascular complications, and depression. [3][4][5] Despite the high prevalence of ED, it is still underdiagnosed and undertreated. ...
... 31 The current study found an increase in prescription of PDE5 inhibitors especially in men with moderate ED which was not assessed in the previous study. 19 ED is associated with increasing age 32 and presence of comorbidities such as cardiovascular diseases, 2 and in some cases, PDE5 inhibitors may not be the first-line or safest option for this population. Conversely, those with mild ED can typically resume sexual activity without oral medicines. ...
Purpose:
Erectile dysfunction (ED) is frequently undermanaged due to communication barriers, particularly among Asian men. We looked at how ED discussion and treatment were affected by the patient's prompt sheet and the Knowledge Translation Tools in the Management of Erectile Dysfunction (LASTED).
Methods:
We conducted a quasi-experimental study in a primary care clinic in Kedah, Malaysia involving 120 Asian men with diabetes. In the intervention group, patients were given a prompt sheet to indicate their intention to discuss or receive ED treatment, and physicians were provided with LASTED to assist with ED consultation. The control group patients received standard care from their physicians.
Results:
The intervention increased the initiation of ED discussion up to 66.7% compared with 8.3% in the control group. In the intervention group, 57.5% of patients were prescribed phosphodiesterase-5 inhibitors and men with ED of moderate severity were more likely to be prescribed oral ED medication. Use of the LASTED flipchart was associated with prescription of phosphodiesterase-5 inhibitors (P = .011) and patient satisfaction with ED consultation (P <.001).
Conclusion:
Our study suggests that using the LASTED flipchart and patient's prompt sheet together may encourage ED conversation and medication prescription particularly when working with Asian men who frequently view ED as a taboo subject.
... 11,12,20 Definition and measurement of variables The primary outcome variable was erectile dysfunction. Using the IIEF-5 questionnaire, ED was classified with scores of 1 to 25: scores of 1-7 (severe ED), 8-11 (moderate ED), 12-16 (mild to moderate ED), 17-21 (mild ED) and [22][23][24][25]. The PHQ-2 was used to screen for depression; it inquires about the frequency of depressed mood and anhedonia over the past two weeks; if the participant's response to both questions is "no", the screen is negative. ...
... 9-12 However, our mild ED prevalence of 36% was higher than those reported in Calabar, South-south Nigeria (16%), 3 Osogbo, South-west Nigeria (29.4%), Ibadan, South-west Nigeria (32.6%,), 11 Ilorin (34.3%, North-central Nigeria), 9 and Malaysia (33.1%) 25 . However, our finding was lower than the 42.7% reported in Ogbomoso, South-west Nigeria. 10 The varying sociodemographic characteristics, prevalence of chronic diseases like hypertension in the study populations and the ED categories analysed could explain the difference. ...
Background: Erectile dysfunction (ED) is a common sexual problem that profoundly affects intimate relationships. It is poorly
studied in North-western Nigeria.
Objectives: To assess the prevalence, severity and predictors of ED among adult males attending a primary care clinic in Northwest Nigeria.
Methods: A cross-section of 392 males (aged ≥25 years) were randomly selected from attendees of a family medicine clinic in
Kano, Nigeria. Information regarding their biodata, lifestyle factors, and clinical characteristics was obtained using a structured
questionnaire. The International Index of Erectile Function Questionnaire (version 5) and Patient Health Questionnaire-2 assessed ED and depression, respectively.
Results: The participants' mean age was 45±14.1 years (range: 26-86 years). Most participants were married (88.8%), had one
sexual partner (71.7%), had tertiary education (44.4%) and were traders (49.7%). The prevalence of ED was 52.3% (205/392)
[comprising mild (36.0%), mild-to-moderate (14.3%), moderate (1.5%) and severe (0.5%)]. Age, body mass index (BMI), marital
status, number of sexual partners, monthly income, type of exercise, hypertension history, blood pressure reading, antihypertensive and peptic ulcer drug use were associated with ED (P<0.05). However, age (≥50years) (OR= 1.91, 95%CI [1.28-2.85],
P=0.001) and overweight/obesity (OR =1.81, 95%CI [1.18-2.77], P=0.007) were the predictors of ED in this population.
Conclusion: ED prevalence was high, although mainly of the mild form. Age (≥50years) and overweight/obesity predicted ED.
Hence, the need for early screening, objective grading of ED, identification of modifiable risk factors (e.g., overweight/obesity)
and commencing proper treatment and prevention in this setting.
... Frequency distribution was generated for percentages and proportions of the various variables. 21,27,14,18 respectively. ...
... The possible reason identified for this high prevalence in this study is an aging population with about three-quarter(79%) of respondents greater than 50 years of age. Although differences exist among prevalence rates of ED 14,27 in the normal population. It was reported by the Massachusetts Male Aging Study, the first land mark study on ED that about 10% of the general population had ED as compared to 45% of the 28 hypertensive population. ...
Background: Erectile dysfunction(ED) among adult hypertensives is common, yet it is under-reported, under-diagnosed and under-treated in primary care. Screening and early diagnosis of erectile dysfunction will reduce its negative effects on the quality of life among hypertensive patients. This study was done at the Family Medicine Department of UITH, Ilorin, Kwara State. The aim was to assess the prevalence, severity pattern and physician enquiry of ED among adult hypertensives. Methods: This study is a descriptive cross-sectional hospital based study. Data was collected from 228 adult hypertensive male patients from June through August 2016 using the International Index of Erectile Function (IIEF-5), and semi-structured questionnaire and was analyzed with Statistical Package for Social Sciences (SPSS 20). Results: The prevalence of ED among respondents was 85.1%, mild in 22.4%, mild to moderate in 28.5%, moderate in 21.5 % and severe in 12.7%. Overwhelming percentage of the respondents (86.8%) had not been asked question related to ED by their physicians. Conclusion: This study showed that ED is a major problem and physician enquiry of ED among hypertensives is very poor.
... 5,8 Male sexual dysfunction affects about 10-25% of middle-aged and elderly men. 9 A study conducted in Malaysia involving men over 40 years old who attended primary care clinic had shown about 69.5% of them reported having ED symptoms. 10 Resumption of sexual activity is one of the important factors of psychosocial recovery after cardiac surgery. Studies have shown mixed results on the effect of CABG on ED. 4,9,11 While the existence of ED in CAD patients and some of the aetiology such as endothelial damage and atherosclerosis are known, the effect of CABG surgery and its impact on ED is controversial. ...
... Descriptive statistics using median (interquartile range) for continuous data and frequency (percentage) was used to summarize data, which included the prevalence of ED symptoms and participant demographics. Participants were then categorized based on IIEF score into those who has ED (IIEF score [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and no ED (IIEF score [22][23][24][25]. ...
INTRODUCTION: Despite the advantages of Coronary artery bypass surgery (CABG), this procedure has been reported to have a significant impact on sexual activity. The study aims to assess the trajectory of change in erectile dysfunction (ED) symptoms following CABG.METHODS: 73 adult male participants were recruited. Participant primary data was measured using the International Index of Erectile Dysfunction (IIEF-5) at three-time points. RESULTS: Severe ED was most prevalent during 6 weeks following-operation (86.3%); however, the proportion of severe ED symptoms reduced after 4 months following-operatively (42.5%). There was a statistically significant difference in ED symptoms between pre-operatively and 6 weeks post- operatively (p< 0.001). At 4 months, there was a marginally significant improvement in ED symptoms compared to baseline pre-operatively post CABG (p = 0.064). Age significantly increases the chance in odds of having abnormal ED symptoms by 22% at 4 months postoperatively (aOR=1.22, 95% CI=1.06, 1.41, p<0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms. However, there was a significant improvement in ED symptoms as the time from surgery increases and patients recovered. Further studies with larger sample size and longer recovery time are needed to assess the trajectory of recovery in ED symptoms in this population.>< 0.05). Other risk factors for abnormal ED symptoms following CABG, which include normal creatinine clearance, being a smoker, and having moderate to good LV function was not statistically significant. CONCLUSION: The present study has demonstrated a high prevalence of ED following CABG and the procedure caused a negative impact on the ED symptoms.
... 3 Of note, ED is also a common presenting problem to primary care facilities whereby few studies found that the prevalence was about 70% for patients attending such facilities. 4,5 The effects of ED are vast involving psychosocial wellbeing, interpersonal relationships, and quality of life for men and their partners. It was once considered a psychogenic disorder, but now has been found to be associated with a variety of organic causes such as endocrine, vascular, and neurological disorders. ...
... 19 However, this was lower in comparison to that in two other studies conducted in the same country, which reported a prevalence of approximately 70%. 4,5 The difference, as such, is due to the lower mean age of the sample collected in our study (48.2 AE 9.2 years); thus, making a comparison with the other studies inaccurate because advancing age in men is a well-known associated factor for ED. ...
Objectives: Undiagnosed glycaemic disorders remain a major health concern as in such cases the opportunity for early interventions that can potentially prevent complications is missed. Erectile dysfunction (ED) has been suggested as a predictor for glycaemic disorders in men. However, data on men with ED having undiagnosed glycaemic disorders is limited, especially in the Malaysian context. This study aimed to identify prevalence and associated factors of undiagnosed glycaemic disorders in men with ED.
Methods: We applied a cross-sectional purposive sampling technique on a group of 114 men with ED without underlying glycaemic disorders. They underwent a 2-h oral glucose tolerance test and the cases were then classified into two groups: normal and undiagnosed glycaemic disorders groups. The glycaemic disorders group consisted of patients with diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG). The patients were interviewed, and their medical records were reviewed for their sociodemographic and clinical profiles.
Results: Prevalence of undiagnosed glycaemic disorders in men with ED was 41.2%. Higher age (adjusted OR = 1.10, 95% CI: 1.03, 1.17, p = 0.002) and BMI (adjusted OR = 1.16, 95% CI: 1.05, 1.29, p = 0.003) were found to be significantly associated with undiagnosed glycaemic disorders.
Conclusion: This study found that men with ED had a high prevalence of undiagnosed glycaemic disorders. ED was associated with advancing age and higher BMI. Further research to validate the findings of this study is needed to increase the prevalence of DM screening among men with ED.
... 3 In Malaysia, the prevalence of ED in men aged 40-79 years is 69.5%. 4 Strengths and limitations of this study ▪ This article represents utilisation of drug treatment and factors associated with comorbidities and concomitant drugs in patients with erectile dysfunction (ED) with multiple comorbidities. The prevalence of ED is increasing worldwide and research papers from the perspective of pharmaceutical care are currently scarce and limited. ...
... 9 A cross-sectional survey conducted in Malaysia found that a larger proportion of patients with ED had hypertension (58.7%), followed by DM (40.9%), hyperlipidaemia (35.5%), obesity (13.1%) and heart disease (8.3%). 4 PDE-5 inhibitors such as sildenafil, vardenafil and tadalafil are first-line therapies for ED with proven safety and efficacy. 10 Various studies showed that PDE-5 inhibitors improve the erectile function in men with comorbidities such as hypertension, DM and hyperlipidaemia. ...
Objective To investigate factors associated with demographic/clinical characteristics and drug selection in patients with erectile dysfunction (ED). The prevalence of ED is increasing worldwide. Studies have shown that ED is associated with age, lifestyle and comorbidities. However, the factors associated with patient characteristics as well as drug selection are incompletely understood.
Setting A tertiary medical centre in Kuala Lumpur, Malaysia.
Participants A total of 219 patients (range 23–80 years) who had received phosphodiesterase type-5 (PDE-5) inhibitors as ED treatment were evaluated.
Inclusion criteria Adult patients aged ≥18 years, diagnosed with ED, and prescribed with sildenafil, tadalafil or vardenafil.
Exclusion criteria Patients diagnosed with ED but who did not receive any PDE-5 inhibitor, or those with missing data.
Primary and secondary outcome measures Factors associated with demographic and clinical characteristics as well as drug selection were assessed.
Results Ischaemic heart disease (p=0.025), benign prostatic hyperplasia (p<0.001), obesity (p=0.005), lower urinary tract symptoms (LUTS) (p=0.006) and α-blockers (p<0.001) were significantly associated with elderly patients with ED. Additionally, LUTS (p=0.038) and α-blockers (p=0.008) were significantly associated with the selection of PDE-5 inhibitor.
Conclusions These data showed that elderly patients with ED were significantly associated with comorbidities and α-blockers, whereas LUTS and α blockers were associated with drug selection.
... This high prevalence is consistent with previous findings in Malaysia (69.5-81.5%) [6,7] and other regions (13.1-71.2%) [25]. ...
Background
Erectile dysfunction (ED) is a common sexual dysfunction among men. This study aimed to determine the prevalence of ED and factors associated with moderate to severe ED among men attending primary care clinics.
Methods
This was a cross-sectional study conducted among men attending four primary care clinics in Selangor, Malaysia. The respondents were selected via systematic random sampling. ED was diagnosed using the five-item Malay version of the International Index of Erectile Function Questionnaire (5-IIEF) and divided into mild and moderate to severe. The respondents with ED were further given a questionnaire consisting of sociodemographic, underlying comorbidities, smoking history, physical activity, and sedentary behaviour. Simple and multiple logistic regression were used for data analysis.
Results
A total of 353 men were diagnosed with erectile dysfunction out of 497 respondents. Only 305 respondents completed the questionnaire. The prevalence of erectile dysfunction was 71% (95% confidence interval [CI]; 67–74%). Multiple logistic regression, revealed that age ≥ 60 years had an adjusted odds ratio (OR) of 8.294, (95% CI: 2.064, 33.322), diabetes mellitus had an adjusted OR of 3.627, (95% CI: 2.080, 6.324), and sedentary behaviour (sitting time ≥ 8 h/day) had an adjusted OR of 5.840, (95% CI: 3.257, 10.471), which were significantly associated with moderate to severe ED.
Conclusion
In conclusion, this study found a high prevalence of erectile dysfunction (ED) among men attending primary care clinics. Age ≥ 60 years, diabetes mellitus, and sedentary behavior were significantly associated with moderate to severe ED. These findings underscore the need for targeted screening and intervention strategies in primary care settings, particularly for older men, those with diabetes, and individuals with prolonged sedentary behaviour.
... 23 However, other Malaysian studies stated that no significant association regarding household income with erectile dysfunction. 6,7,24 The limitation fo this study was that the data was obtained by self-reporting, which might have lead to recall bias. Also, there might be reporting bias from responders about ED, where gender issues are not openly acknowledged. ...
INTRODUCTION: Erectile dysfunction (ED) is a significant issue that should not be ignored in the clinical setting and can negatively affect the quality of life of patients and their partners. This study aims to determine the prevalence of ED and its associated factors among men who visited 12 government health clinics in Kuantan, Pahang, Malaysia. MATERIALS AND METHODS: Between July and October 2021, 300 males aged 18 to 60 participated in this cross-sectional study at 12 government health clinics in Kuantan. Information on demographic data, medical history, and lifestyle of the participants was obtained through a self-administered questionnaire that included a validated Malay version of the 21 item Depression Anxiety Stress Scale (DASS 21) and the International Index of Erectile Function (IIEF-5). RESULTS: The overall prevalence of self-reported ED was 69.3%. In terms of severity, 45.7% had mild, 20.7% mild-to-moderate, 2.3% moderate, and 1% severe ED. Multivariate analysis showed that ED associated with diabetes (OR 2.97, 95% CI 1.13–7.79); anxiety (OR 2.85, 95% CI 1.06 – 7.67) and household income (OR 0.41, 95% CI 0.18–0.95). CONCLUSION: ED was high in our study population. Diabetes mellitus, anxiety and household income were significantly associated with ED.
... Currently, more than 150 million people worldwide have ED (Irwin, 2019), presenting a 52% prevalence across all severities in the United States (Rosen, 2001) and a 30% prevalence of ED across eight European centres (Irfan et al., 2020a) and affecting more than 63% of men aged 50-80 years old across Asian countries (Ho et al., 2011;Irfan et al., 2020a). In Malaysia, the prevalence of ED is 81.5% in a primary healthcare setting (Low et al., 2006;Ab Rahman et al., 2011). ...
Erectile dysfunction (ED) is one of the common sexual disorders affecting many men worldwide. Owing to shared common risk factors, periodontitis is related to ED. However, the prevalence of periodontitis among Malaysian patients with ED is currently unknown. This study aimed to investigate the prevalence of periodontitis in patients with ED in Malaysia and the factors associated with this relationship. Forty-one subjects aged 27–59 years old were recruited to participate in this study. The International Index of Erectile Function (IIEF-5) was used in assessing the presence of ED. Their periodontal health was assessed through comprehensive periodontal examination including plaque index, bleeding on probing and clinical attachment level. The subjects were categorised according to the severity of their periodontal health and ED. A questionnaire on general health and oral habits was administered. The prevalence of periodontitis (95.5%) among subjects with ED was significantly higher than those without ED (52.6%). Subjects with ED had the worst periodontal health, as indicated by the mean clinical attachment loss and percentage of sites with bleeding on probing. No differences in oral hygiene habits were found between subjects with and without ED. The prevalence of periodontal disease among Malaysian patients with ED was high. Periodontitis was positively associated with the severity of ED, supporting a dose-dependent association between the two diseases. Oral hygiene habits were not significantly related to any periodontitis parameters nor were significantly different between subjects with and without ED.
... It affects millions of men worldwide. The reported prevalence of erectile dysfunction in Malaysia is about 70% for those above 40 years old, ranging from mild to severe ED [2,3]. However, many of these patients are untreated [4]. ...
Background: Erectile dysfunction (ED) affects millions of men worldwide yet many are undiagnosed and untreated. Both doctors and men may have a miscommunication that ED is taboo to be brought up in the consultation. This study determined the effectiveness of prompt sheet in initiating a discussion of sexual dysfunction in a primary care setting. Methods: This was an open label control trial done at two government primary care clinics, one as a control and the other, an intervention group. All doctors in the participating clinics were given education on diagnosis and management of ED. Participants who came for their diabetes mellitus follow-up were approached. Those who consented to the study had their sociodemographic data recorded and erectile function evaluated using International Index of Erectile Function (IIEF-5). The patients in the intervention group (n = 69) received a prompt sheet allowing participants to indicate their decision, prior to consultation, of whether to discuss about erectile dysfunction. The prompt sheet was presented to their treating doctors during consultation. The control group (n = 65) received usual care. All participants would provide a written feedback whether there was any discussion about erectile dysfunction after the consultation. Results: A total of 134 participants completed the study. Ethnic distributions in intervention group differed significantly from the control group with 46.4% Chinese, 44.9% Malay, 7.2% Indian and 53.8% Chinese, 15.4% Malay, 29.2% Indian respectively. Other baseline characteristic of both groups (age, body weight, education level, employment, smoking, marital status, duration of diabetes and prevalence of ED) were similar. The prevalence of ED in both groups was about 80%. In the intervention group, only 59% of participants opted to discuss their sexual problems and among them, 80.5% of them had it discussed during the consultation. Thus, in the intervention group, 47.8% of total participants discussed about erectile dysfunction, compared to 4.6% in the control group (Odds Ratio (OR) 18.4, 95% Confidence Interval (CI): 5.4–66.2, p < 0.001). Sub-analysis did not reveal any relationship between either ethnicity or severity of ED and participant’s option to discuss ED. Conclusions: Prompt sheet is a simple and inexpensive tool to cue a discussion of erectile dysfunction during consultation. More importantly, prompt sheet provides patients an opportunity to indicate their interest of discussing ED to bridge the gap of miscommunication between men and doctors.
... In Malaysia that prevalence is up to 89.2%. 5 These patients are more likely to have severe ED, which is less responsive to medical treatment and leads to lower QOL. 6,7 Due to its significance, risk perception for developing ED is important to evaluate because it potentially affects their help-seeking behavior. ...
Risk perception for developing erectile dysfunction (ED) is an appreciation of the susceptibility to having ED and its severity. This study examined this risk perception and its associated factors among 180 men with type 2 diabetes mellitus (T2DM), who claimed not to have ED. This cross sectional study was conducted at a public health clinic using a validated self-administered questionnaire, which assessed participant characteristics, perceived susceptibility to developing ED, perceived severity of ED, and knowledge on risk factors for ED. About 71.1% had an inaccurate perception of susceptibility to developing ED and their perception on its severity was moderate (median (IQR) score: 10.0 (6.0); range score: 3–15; midpoint: 9). In multiple linear regression, having ED symptoms (p-value < 0.001) and secondary (p-value = 0.045) or tertiary education (p-value: 0.022) significantly contributed to a higher perception of susceptibility. A higher perception of severity was significantly found in Malays (p-value < 0.001), the employed (p-value = 0.026), and those with better knowledge on risk factors for ED (p-value < 0.001). Risk perception for developing ED among men with T2DM appears poor and it was significantly influenced by sociocultural factors, educational attainment, ED symptoms, and knowledge on risk factors for ED. Thus, to improve their risk perception, they should be provided appropriate counseling and education.
... 8 Another similar study done in New Zealand showed the prevalence of 42%. 9 In a country in West Africa, the prevalence was noted to be about 27%, 10 whereas in China a pooled prevalence from a few studies was about 49.7%. 11 In Malaysia, the prevalence appears to be one of the highest with a study in a primary care setting with a prevalence of 69.5% 12 and another community study with a prevalence of 69.2%. 13 There are many factors that contribute to the development of ED and usually it is multifactorial in origin. ...
Background
Erectile dysfunction (ED) is a common problem among men across the world. It is usually multifactorial in origin. Behavioral factors can be related to the development of ED and related to many other chronic diseases. It impacts not only the sexual function but also the psychology and their overall quality of life.
Aim
To determine the association of the behavior factors in relation to ED and to identify the risk and protective factors.
Method
A systematic review search based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted. The primary databases PubMed, PlosOne, Oxford Academic, SCOPUS, and Ovid were accessed using specific keyword searches. Quality of articles was assessed by using Newcastle-Ottawa Assessment Scale according to the study design.
Outcome
Evaluation of the relationship between behavioral factors and ED.
Results
24 studies were identified from the 5 databases which met the predetermined criteria. Overall, the study population include adult male age between 18 and 80 years. The sample size of the studies ranges from 101 to the largest sample size of 51,329. Smoking, alcohol, and drugs usage are found to be risk factors for ED. Meanwhile, dietary intake, physical activity, and intimacy are the protective factors for ED.
Clinical Implication
The findings from this review may aid clinicians to aim for early detection of ED by screening their risk factors and providing early treatment. This can also be used to promote awareness to the community on the sexual health and factors that can affect their sexual function.
Strength & Limitation
This study looks at all types of behavioral factors that may affect ED; however, there was a substantial heterogeneity detected across the selected study factors. Furthermore, the lack of PROSPERO registration is also a limitation in this study.
Conclusion
Overall, smoking, dietary intake, alcohol consumption, drugs, and physical activities are modifiable risk factors for ED in men. Therefore, it is crucial to promote healthy lifestyle and empower men to prevent ED and early detection of ED for early treatment.
Sivaratnam L, Selimin DS, Abd Ghani SR, et al. Behavior-Related Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2020;XX:XXX–XXX.
... This study also did not explore the presence of male sexual dysfunction though it may potentially contribute to female sexual dysfunction. Furthermore, the prevalence of erectile dysfunction in Malaysia is high [35], hence information on the presence of male sexual dysfunction may provide valuable information to interpret the high prevalence of female sexual dysfunction in this study. ...
Purpose
This study aims to determine the prevalence of sexual dysfunction during pregnancy and to determine its associated factors.
Methods
This 6-month cross-sectional study adopted convenience sampling; inclusion criteria were healthy pregnant women, sexually active and living together with their partner for 3 months prior to recruitment into this study. Women who received advice to avoid sexual intercourse, with any medical illness and/or those conceived via assisted reproductive technology were excluded. Participants filled in a questionnaire consisting of demographic details and Malay Version Female Sexual Function Index Questionnaire. Data were analysed using SPSS 24.0; categorical data were analyzed by Chi-square and Fisher exact test.
Results
One hundred pregnant women with a mean age of 31 + 4.31 years old participated. By using the cut-off FSFI score of 26.55, 81 (81%) participants were diagnosed to have sexual dysfunction. The mean FSFI score was 20.41 ± 8.45 (range 2.6–33.5; median 23.6). All the mean FSFI scores of first, second and third trimesters were low with 22.80 ± 10.67, 23.81 ± 7.18 and 18.74 ± 8.43, respectively. The mean score for desire, arousal, satisfaction and pain were significantly lower in the third trimester than earlier gestation. There was a significant difference in the incidence of difficulties in desire, arousal, lubrication, satisfaction and pain between first and second trimester combined, as compared to the third trimester of pregnancy. Trimester of pregnancy was found to have a significant association with the incidence of sexual dysfunction.
Conclusion
Sexual dysfunction among pregnant women is a significant burden. Despite being a common health problem, it is often neglected.
... The reported prevalence of ED was in the range of 18.4% (US) and 69.5% (Malaysia). (23,24) Using 18.4% prevalence, the calculated sample size was 276 (230 + potential dropout 20%). However, when using 69.5% prevalence, the calculated sample size was 646. ...
Introduction:
Erectile dysfunction (ED) is a serious burden globally that affects men as well as their partners. Therefore, the aim of this study was to determine the prevalence and predictors of ED among male outpatient clinic attendees in Johor, Malaysia.
Methods:
A cross-sectional study of Malaysian men aged 18 and older attending two major outpatient clinics in Johor Bahru and Segamat between 1 January and 31 March 2016 was undertaken. Subjects were chosen via simple random sampling and a sample size of 400 was recruited. The study instrument was a survey form that consisted of three sections: sociodemographic and comorbid profile, validated English and Malay version of the 15-item International Index of Erectile Function (IIEF-15) and 21-item Depression Anxiety and Stress Scale (DASS-21).
Results:
The overall prevalence of self-reported ED was 81.5%. The prevalence of ED according to severity was as follows: mild (17%), mild to moderate (23.8%), moderate (11.3%), and severe (29.5%). Multivariate analysis showed that ED was associated with increasing age (odds ratio [OR] 4.023, 95% confidence interval [CI] 1.633-9.913), Indians as compared to Malays (OR 3.252, 95% CI 1.280-8.262), secondary as compared to tertiary education (OR 2.171, 95% CI 1.203-3.919), single as compared to married status (OR 6.119, 95% CI 2.542-14.734), and stress (OR 4.259, 95% CI 1.793-10.114).
Conclusion:
There is significant prevalence and severity of ED among adult male outpatient clinic attendees in Johor. Increasing age, Indian ethnicity, lower educational level, being single, and stress were significant predictors of ED.
... 5 ED has been shown to be associated with the use of didanosine, as well as other protease inhibitors. 3 Furthermore, a local study reported that other psychosocial issues, such as depression, anger, guilt, feelings of being a failure and the feeling of letting a partner down during intercourse, were significantly associated with patients suffering from ED. 6 According to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), ED is characterized by a recurrent inability to achieve or maintain an adequate erection during partnered sexual activities. 7 ED can have a profound impact on an individual's perceived quality of sexual life, which can further affect a patient's compliance towards ARV regimens; their sexual performance may also be affected. ...
Introduction: Erectile dysfunction (ED) has been associated with the treatment of human immunodeficiency virus (HIV) and chronic diseases. Sexual dysfunction data of male patients infected with HIV are still scarce in Malaysia, and ED appears to be under-reported. Therefore, this study aims to determine the prevalence and predictors of ED among male HIV patients at the University Malaya Medical Centre. Methods: A cross sectional study was conducted among male HIV patients on antiretroviral therapy (ART) attending the outpatient clinic of a teaching hospital in Malaysia. A systematic random sampling method was employed in the selection of respondents. Participants were interviewed using a structured questionnaire with a 15-item international index of erectile function (IIEF-15). An appropriate statistical analysis was used to determine the associate and potential risk factors. Results: A total of 220 males participated in this study with a mean age of 37.9±9.9; prevalence of ED among HIV patients was 82.3 % (n=180). The severity of ED was further categorized into: severe (24.1%), moderate (19.1%), mild to moderate (20.9%), and mild (18.3%). In a multivariate logistic regression analysis, patients with a lower educational background were more likely to be associated with ED (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.02-6.72; p-value 0.046). Conclusion: This study reports that ED was prevalent among adult HIV males who are on an ART regimen. Those with a lower educational background are more likely to have ED. Hence, in managing patients with HIV, physicians should seek to identify those patients at risk of developing ED for further intervention.
... The prevalence of ED found in our study was in concordance with the prevalence of ED among patients on MMT reported in other studies, which ranged from 50% to 93% (Hallinan et al., 2008;Quaglio et al., 2008; Jaafar et al. (2013). Among Malaysian men aged 40 and above, patients in our study had a slightly higher prevalence of ED (73.2%) than the general population (ranging from 60% to 69.5%) but a notably higher prevalence of severe ED (25.4%) compared with the general population (9.8%) (Thambi, 1998;Ab Rahman et al., 2011). The fact that our prevalence was based on a self-reported questionnaire showed that patients may be willing to express their issues with sexual health if asked by clinicians, thus sexual dysfunction is an issue that should be addressed among patients undergoing methadone treatment, despite the perception of the issue as a taboo. ...
Objectives:
Erectile dysfunction (ED) is a problem commonly encountered by patients on methadone maintenance therapy (MMT). This study aimed to assess the prevalence of ED among this group of patients along with its risk factors and association with quality of life (QOL).
Methods:
Male patients on MMT in a tertiary hospital in Malaysia were included in the study. A total of 134 patients with sexual partners were assessed for ED using the International Index of Erectile Function. Patients were assessed for substance use using Opiate Treatment Index (OTI) and depression using the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM). QOL was evaluated using World Health Organisation Quality of Life (WHOQOL)-BREF.
Results:
The prevalence of ED among patients on MMT was 67%, with 26.1% having mild ED, 30.4% having mild-to-moderate ED, 7.0% having moderate ED, and 17.2% having severe ED. Patients with depression were 4 times more likely to have ED compared with patients without depression, whereas increasing age significantly correlated with the severity of ED. Having ED predicted a poorer QOL in the social relationships domain.
Conclusion:
Depression is highly associated with ED, which negatively influences the social aspect of QOL among patients on methadone maintenance therapy.
... An unexpected finding was that 52% of participants reported symptoms of erectile dysfunction. Little is known about the prevalence of erectile dysfunction in Malaysia, but a 2011 study of men aged 40-79 years who frequented public primary care clinics in an urban district in Malaysia reported a rate of 69.5% (Ab Rahman et al. 2011). A more recent study quoted figures ranging from 11% to 47%, depending on the age of men (Koh 2013). ...
Despite the rise in recreational use of ketamine in Malaysia, there have been no studies of users or of the health-related consequences they face. This study was initiated to examine ketamine use and its health consequences. A structured questionnaire was used to elicit information. A final sample of 127 males was divided into persons who used only ketamine and those who were poly-drug users. Each group was further divided into long-period and short-period users. Urine toxicology screening for ketamine and other illicit drugs commonly used in Malaysia was also done. Our findings corroborate those of earlier studies that link ketamine use to urological problems such as frequent urination, dysuria, incontinence, painful bladder, nocturia, and urinary urgency. A new finding in this study is the significant association between ketamine use and erectile dysfunction, such that higher odds of reporting erectile dysfunction were linked to long-period users. Our findings strengthen the case for early intervention, as ketamine users are drawn from young and unmarried male participants. The association of ketamine use with erectile dysfunction, if substantiated, will help physicians in their diagnosis of erectile dysfunction, particularly among youths.
It has been hypothesized that the quality of life for men who suffer from ED is lower than that of men who do not suffer from ED. Men with ED also have a negative effect on their female partners' quality of life, who may have problems in their relationships and a decline in their level of happiness in their partnership. This research investigates these two hypotheses in the context of Malaysia. We employed Ferrans and Power's Quality Of Life Index to assess the life qualities of the husband and wife. The International Index of Erectile Function (IIEF) is used to determine the level of erectile dysfunction. The data estimation suggested that erectile dysfunction has significant negative impacts on the life quality index of both husband and wife. Even though ED is not a deadly illness, the results of this research show that improved management and availability of effective ED treatments are needed to assist reduce the intimacy cost of this condition. These results also highlight the need for increased knowledge about ED, a better grasp of the various treatment choices, and a greater comprehension of the physical and mental cost that ED may put on men and their relationships.
Low‐intensity shockwave therapy (LiSWT) has emerged as a promising non‐invasive treatment modality for erectile dysfunction (ED) yet the well‐designed randomized clinical trials are still lacking to prove its claimed benefits. A randomized, prospective, double‐blinded sham‐controlled study was conducted to evaluate the effectiveness and safety profile of short course LiSWT on vasculogenic ED patients. The International Index of Erectile Function‐5 (IIEF‐5) and Erection Hardness Score (EHS) questionnaires were used for evaluation. Patients underwent weekly sessions for 4 weeks and were re‐assessed at 1, 3 and 6 months post therapy. Fifty one patients were recruited and randomized into sham and treatment arms. The mean IIEF‐5 scores were significantly improved in the treatment arm compared to worsening of scores in the sham arm after 1 month (14.1 vs. 9.3 p < 0.001), 3 months (14.9 vs. 8.6, p < 0.001) and 6 months (14.2 vs. 7.9, p < 0.001) post treatment. A significant improvement of EHS was demonstrated at 1 month (2.4 vs. 1.8, p = 0.001, 3 months 2.7 vs. 1.7, p < 0.001) and 6 months (2.7 vs. 1.6, p < 0.001) in the treatment arm compared to sham arm. The success rate based on IIEF score increment more than five points was 26% in treatment arm and 0% in sham arm. Improvement in EHS score ≥3 in the treatment versus sham arm was 63% and 4%, respectively. There was no adverse effect reported. This 4‐week LiSWT protocol reflects better treatment compliance, and it prevents further deterioration of erectile function among this cohort of patients. This study proves that LiSWT is a well‐tolerated treatment with modest improvements in erectile function and hardness, among patients with vasculogenic ED.
Introduction: Erectile dysfunction (ED) is a serious health problem and an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between physical fitness and ED especially among men with high risk of CVD. Hence, this study aimed to determine the prevalence of ED among men with Metabolic Syndrome (MetS) and its association with hand-grip strength in which is a measurement of physical fitness and muscle strength.
Methods: A cross-sectional study was conducted among Malaysian men aged ≥ 40 years who had their follow-up between 1st June 2021 and 30th October 2021 at an institutional primary care clinic in Gombak district, Selangor, Malaysia. The participants were recruited via computer generated simple random sampling. Data on sociodemographic, comorbidities, anthropometry, clinical examinations including hand-grip strength (HGS) and blood chemical profiles were collected. While a validated English and Malay versions of the 5-item International Index of Erectile Function (IIEF-5) were used to assess presence of ED. Multiple logistic regression analysis were conducted to determine the association between sociodemographic, comorbidities, blood chemical profiles, and HGS with ED.
Results: There were 334 participants recruited in the study. The mean age was 58.8 (±8.84) years old, with majority were Malays (95.2%, n= 318) and married (98.8 %, n=330). The overall prevalence of self-reported ED was 79% (95% confidence interval [CI]: 0.75-0.84). Multivariable analysis showed that ED was associated with elderly aged ≥ 60 years (odds ratio [OR] 3.27, 95% CI: 1.60-6.69), HGS (OR 15.34, 95% CI: 5.64-41.81) and abnormal total cholesterol (OR 0.36, 95% CI: 0.16-0.78).
Conclusion: ED was highly prevalent among Malaysian men aged ≥ 40 years with MetS. Being older than 60 years of age and low HGS are associated with higher risk of ED. Robust screening of ED among men with Mets and intervention to improve muscle strength and physical fitness may be warranted.
Introduction: Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. Methods: Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. Results: The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8-18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40-69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. Conclusions: SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years. Enfermedad cardiovascular; Disfunción eréctil; Prevalencia Prevalencia de la disfunción eréctil en el ámbito de la atención primaria española y su asociación con factores de riesgo cardiovasculares y enfermedades cardiovasculares. Estudio SIMETAP-ED Resumen Introducción: Existen pocos estudios realizados en atención primaria sobre prevalencias ajus-tadas por edad de la disfunción eréctil (ED, por sus siglas en inglés). Los objetivos del estudio SIMETAP-ED fueron determinar las prevalencias crudas y ajustadas por edad del diagnóstico de la ED, comparar estas tasas con otros estudios similares, y comparar las prevalencias de fac-tores de riesgo cardiovasculares (FRCV), enfermedades cardiovasculares (ECV), enfermedades metabólicas y enfermedad renal crónica (ERC) entre las poblaciones con y sin ED. Prevalence of erectile dysfunction in Spanish primary care setting and its association 103 Métodos: Estudio observacional transversal realizado en atención primaria. Muestra aleatoria base poblacional: 2.934 varones adultos. Tasa de respuesta: 66%. Se realizó una entrevista clínica para diagnosticar ED mediante una pregunta derivada de la definición de ED. Se revisaron las historias clínicas de los pacientes para identificar sus FRCV y enfermedades asociadas con la ED. Los ajustes de tasas se estandarizaron con respecto a la población española. Resultados: Las prevalencias de enfermedades metabólicas, ECV, FRCV y ERC en la población con ED fueron más altas que en la población sin ED, destacando las ECV. La prevalencia cruda de la ED fue del 17,21% (intervalo de confianza del 95%: 15,86-18,63). Las tasas de prevalencia ajustadas por edad de la ED fueron del 0,71% en menores de 40 años, del 12,4% en mayores de 18 años, del 10,8% en varones entre 40 y 69 años, del 18,9% en mayores de 40 años y del 48,6% en mayores de 70 años. Conclusiones: El estudio SIMETAP-ED mostró asociación de la ED con las enfermedades metabólicas, ERC, FRCV y, sobre todo, con ECV. La prevalencia ajustada por edad de la ED fue del 12,4% en varones adultos, del 19% en mayores de 40 años y casi del 50% en mayores de 70 años.
Introduction:
Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED.
Methods:
Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population.
Results:
The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8-18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40-69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years.
Conclusions:
SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.
This study was conducted in a tertiary medical center in Kuala Lumpur, Malaysia. A total of 200 erectile dysfunction (ED) patients with 499 cases who had received pharmacological treatments for their ED participated in this study. Types, causes and factors associated with drug-related problems (DRPs) in ED patients with multiple comorbidities were assessed. A total of 244 DRPs with an average of 1.2±2.1 DRPs per patient were identified. Drug interaction contributed the most to DRPs occurrence. There was a significant higher risk of DRPs in patients with benign prostatic hyperplasia, lower urinary tract infection and elderly and end-stage renal disease. Early identification of types of DRPs and factors associated may enhance their prevention and management.
Background
Erectile dysfunction (ED) is one of the most common health problems in men. ED can significantly affect a man’s psychological well-being and overall health.
Purpose
To investigate the association of psychological factors, patients’ knowledge, and management among ED patients.
Patients and methods
A total of 93 patients with an age range from 31 to 81 years who have undergone treatment for ED were included in this study.
Results
It was found that the feeling of blame (P=0.001), guilt (P=0.001), anger or bitterness (P=0.001), depression (P=0.001), feeling like a failure (P=0.001), and the feeling of letting down a partner during intercourse (P=0.001) were significantly associated with ED. Age was also found to be significantly associated with patients’ psychological scale (P=0.004). In addition, the majority of patients in this study practice the right method of administration of ED therapy. However, no significant correlation was found between patients’ knowledge of ED therapy and demographic characteristics.
Conclusion
This study concluded that ED does affect psychological well-being of people. In addition, patient’s knowledge about ED and its management is also crucial in ensuring that the patient achieves optimal therapeutic outcomes from ED therapy.
To assess the pathophysiologic composition and age structure of erectile dysfunction (ED) in men visiting outpatient clinics in China.
We studied 3327 consecutive ED outpatients (median age 39 years) from 2006 to 2010 in the 5 training hospitals in China. Every patient was independently evaluated by an experienced urologist/andrologist using comprehensive diagnostic procedures. The simplified International Index of Erectile Function was used to assess the severity of ED.
Most patients (95.0%) were <60 years old, and none were >70 years old. The psychogenic patients were younger and had greater percentage than any other patients. Vasculogenic factors were a major etiology of organic ED. A significant difference was found in the age distribution between the patients with psychogenic ED and those with organic ED (P = .000). Diabetes, hypertension, coronary artery disease, and hyperlipidemia played significant roles in affecting the severity of ED in a statistical model, including age. The International Index of Erectile Function scores decreased with age (rs = -0.199, P = .000). Moreover, the percentage of severe and moderate cases increased with age (P = .003 and P = .002, respectively). However, the constituent ratio of patients sharply declined from 30.3% to 4.5% with age.
The number of men visiting outpatient clinics with psychological ED is greater than the number with organic causes in China. The age of the Chinese patients with ED who seek medical help is young and this is mainly because of inadequate sex education to young men and because most older patients are reluctant to visit the hospital just for the loss of erectile function.
A systematic review was conducted on the prevalence of erectile dysfunction (ED) in the general population. Studies were retrieved which reported prevalence rates of ED in the general population. Using a specially developed criteria list, the methodological quality of these studies was assessed and data on prevalence rates were extracted. We identified 23 studies from Europe (15), USA (5), Asia (2) and Australia (1). On our 12-item criteria list, the methodological quality ranged from 5 to 12. The prevalence of ED ranged from 2% in men younger than 40 y to 86% in men 80 y and older. Comparison between prevalence data is hampered by major methodological differences between studies, particularly in the use of various questionnaires and different definitions of ED. We stress the importance of providing all necessary information when reporting on the prevalence of ED. Moreover, international studies should be conducted to establish the true prevalence of ED across countries.
The prevalence and correlates of erectile dysfunction (ED) in developing countries are largely unknown. Our objectives were to determine the prevalence and associated factors of ED in three countries (Pakistan, Egypt, Nigeria) that represent very different cultures. Men 35-70y of age seeking primary medical care answered a structured questionnaire adapted to reflect local cultures. Degree of ED was categorized as 'none,' 'mild,' 'moderate,' or 'complete.' The age-adjusted prevalence rates of ED among men attending primary care clinics was 57.4% in Nigeria, 63.6% in Egypt, and 80.8% in Pakistan. Older age, diabetes, peptic ulcers, prostate disease, depression-related symptoms, and caffeine consumption were independently associated with increased prevalence of ED, whereas being moderately active to very active at work (hard physical labor) and during leisure time (strenuous exercise) was associated with half the prevalence of moderate-to-complete ED. Our multicultural study demonstrates that in every country studied, high proportions of men older than age 35 have some degree of ED (57-81%). Both severity and prevalence increase consistently with age. Factors associated with ED are similar, but their distribution differs across countries.
The prevalence of erectile dysfunction (ED) in men visiting outpatient clinics was analyzed using data reported by 1352 randomly chosen physicians who were requested to interview five to 20 consecutive patients aged >or=40 years about the presence of ED. A total of 25.12% of the physicians returned the questionnaires, containing data on 3552 patients, of whom 42.7% had ED, 44.9% had no ED and 12.4% declined to answer the questions. The duration of ED was <1 year in 8.1% of patients, 1-2 years in 32.2% and >2 years in 59.7% of patients. 86.4% of men with ED had >or=1 chronic disease. ED was present in 70.3% of men with coronary heart disease, 67.8% of those with hypertension, 78% of those with diabetes and 70.5% of patients with psychiatric diseases. 93.2% of patients with ED used one or more drugs chronically. In conclusions, 42.7% of men visiting outpatient clinics had ED. Patients with ED often had one or more chronic diseases and used at least one drug chronically. Older patients are less inclined to talk to their physicians about sexual problems.
In order to assess the prevalence and associated factors for erectile dysfunction (ED) in primary care, a cross-sectional study was undertaken by questionnaire distributed to consecutive adult male attendees at 32 family practices. ED was assessed by the Korean five-item version of the International Index of Erectile Function (IIEF-5). In total, 3501 completed questionnaires were available for analysis. The prevalence of ED was severe (IIEF-5 score: 5–9) in 1.6% of cases, moderate (10–13) in 10.2%, mild (14–17) in 24.7%, and normal (18–25) in 63.4%. The prevalence of ED increased with age, lower educational status, heavy job-related physical activity, and lower income. ED prevalence was significantly higher in patients with chronic diseases such as diabetes, depression, and anxiety. These results suggest that the age-adjusted prevalence of ED among Korean men can be estimated as 32.2% (95% CI 30.6–33.7). Low socioeconomic status and several diseases such as diabetes, anxiety, and depression, as well as age, were associated with ED.
Erectile dysfunction (ED) is a common problem in general medical practice affecting especially the elderly and those with cardiovascular disease and diabetes mellitus. A study was undertaken by questionnaire distributed to consecutive adult male attendees at 62 general medical practices. 1240 completed questionnaires were available for analysis. The mean age of participants was 56.4y (range 18-91 y). 488 men (39.4%) reported ED: 119 (9.6%) 'occasionally', 110 (8.9%) 'often', and 231 (18.6%) 'all the time' (complete ED). Among 707 men aged 40-69y 240 (33.9%) reported ED and 84 (11.9%) had complete ED. The prevalence of complete ED increased with age, rising from 2.0% in the 40-49 y age group to 44.9% in the 70-79 y age group. Only 11.6% of men with ED had received treatment. Hypertension, ischaemic heart disease, peripheral vascular disease and diabetes mellitus were frequently associated with ED. 40% of diabetic men aged 60 y or older had ED all the time.
To measure the prevalence of erectile dysfunction (ED) in community-based populations in Brazil, Italy, Japan, and Malaysia and to study its association with the demographic characteristics, medical conditions, and health-related behavior.
In each country, a random sample of approximately 600 men aged 40 to 70 years was interviewed using a standardized questionnaire. All the data were self-reported. ED was assessed by the participants' "ability to attain and maintain an erection satisfactory for sexual intercourse," and the men were classified as not having ED if they answered "always" and as having mild, moderate, or complete ED if they answered "usually," "sometimes," or "never," respectively.
The age-adjusted prevalence of moderate or complete ED was 34% in Japan, 22% in Malaysia, 17% in Italy, and 15% in Brazil. The overall age-specific prevalence of moderate or complete ED was 9% for men aged 40 to 44 years, 12% for 45 to 49 years, 18% for 50 to 54 years, 29% for 55 to 59 years, 38% for 60 to 64 years, and 54% for those 65 to 70 years. The increased risk of ED was associated with diabetes, heart disease, lower urinary tract symptoms, heavy smoking, and depression and increased by 10% per year of age. It was inversely associated with education, physical activity, and alcohol drinking.
ED is an international problem, the prevalence and severity of which increases with age. Despite national variations in prevalence, uniform associations were found between ED and medical conditions and lifestyle habits.
This review of the current epidemiological literature on erectile dysfunction (ED) suggests that approximately 5-20% of men have moderate-to-severe ED. Different definitions of ED, age distributions and concomitant medical conditions, as well as methodological differences, may explain much of the variance in reported prevalence rates. Various chronic disorders are associated with elevated rates of ED including depression, diabetes, and cardiovascular and neurological diseases. Such disorders are more common in the elderly, which may partially explain the elevated prevalence of ED in men over 60 y of age. Currently, up to 70% of men with ED are not treated. However, so many men experience considerable distress from their condition, that the increasing awareness of ED as well as the availability of noninvasive treatments may result in a greater proportion of patients seeking treatment, and eventually regaining satisfaction with their sex life.
The objective of this study was to estimate the prevalence of erectile dysfunction (ED) and its health-related correlates among Danish men, to evaluate the influence of age, tobacco smoking, educational level and medication and the needs for treatment and willingness to be treated. A validated questionnaire was sent to 4310 noninstitutionalized Danish men, aged 40-80 y. The men selected constituted all male patients aged 40-80 y in 12 general practitioner practices in a county of Zealand, representing both the urban and rural population. Besides age, education, marital status and International Index of Erectile Function, the questionnaire included the duration of sexual problems (ED, premature ejaculation, penile curvature), comorbidity, medication, risk factors and the effect of prior treatment and willingness to seek treatment for sexual problems. A total of 2210 men responded, giving a response rate of 51.3%. No difference in the response rate by age groups was noted. The prevalence of complete ED increased with increasing age: 40-45 y, ED: 4.5%; 50-55 y, ED: 11.1%; and 75-80 y ED: 52%. The frequency of ED increased three-fold from men without comedication to men having some kind of medical treatment. Risk factors included tobacco smoking and low educational level. Only 9% suffering from ED had received some kind of treatment. Of the treated men, 75% were satisfied with the treatment. Willingness to discuss sexual matters depended both upon the age of the man and his actual erectile function. Taboos were seen more frequently among elderly people. ED increases with age, but only 10% of the men with sexual problems seek advice. Medication predisposes to ED.
Erectile dysfunction (ED), assessed clinically by tools such as the International Index of Erectile Function (IIEF), affects millions of men across the world. Around 10-25% of men of all ages are affected rising to 20-45% in older age groups. Different definitions of ED and selection of different patient populations account for much of the variability reported in epidemiological surveys. Ageing populations in the developed world and growing populations in the developing world make it likely that the prevalence of ED will increase in the future. ED affects quality of life, and the condition may result in outcomes such as anxiety and withdrawal from a relationship. The condition remains a source of embarrassment for many men and health professionals, and it remains under-reported, under-recognized, and undertreated. Adequate medical assessment and intervention are needed to address ED.
The prevalence of erectile dysfunction (ED) and associated risk factors has been described in many clinical settings, but there is little information regarding men seen by primary care physicians. We sought to identify independent factors associated with ED in a primary care setting.
We surveyed a cross-sectional sample of 3921 Canadian men, aged 40 to 88 years, seen by primary care physicians. Participants completed a full medical history, physical examination, and measurement of fasting blood glucose and lipid levels. We used the International Index of Erectile Function to define ED as a score of less than 26 on the erectile function domain.
The overall prevalence of ED was 49.4%. The presence of cardiovascular disease (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.16-1.81; P<.01) or diabetes (OR, 3.13; 95% CI, 2.35-4.16; P<.001) increased the probability of ED after adjustment for other confounders. Among those individuals without cardiovascular disease or diabetes, the calculated 10-year Framingham coronary risk (OR, 1.03 per 1% increase; 95% CI, 1.02-1.05; P<.001) and fasting blood glucose levels (OR, 1.14 per 18-mg/dL [1-mmol/L] increase; 95% CI, 1.04-1.24; P<.01) were independently associated with ED. Erectile dysfunction was also independently associated with undiagnosed hyperglycemia (OR, 1.46; 95% CI, 1.02-2.10; P = .04), impaired fasting glucose (OR, 1.26; 95% CI, 1.08-1.46; P = .004), and the metabolic syndrome (OR, 1.45; 95% CI, 1.24-1.69; P<.001).
Cardiovascular disease, diabetes, future coronary risk, and increasing fasting glucose levels are independently associated with ED. It remains to be determined if ED precedes the development of these conditions.