Abstract
It has been reported that patients frequently discontinue treatment for erectile dysfunction (ED) with phosphodiesterase type 5 inhibitors (PDE5Is) despite apparently good therapeutic results. Because expectations have been shown to affect patients’ appraisals of many drugs, the purpose of this study was to determine whether expectations affected the therapeutic response to PDE5Is in men with apparent psychogenic ED. An unvalidated questionnaire was used to collect data on expectations in 80 men commencing PDE5I therapy, and after three and six months of treatment. At the same time, subjects completed the International Index of Erectile Function (IIEF), the Sexual Excitation/Inhibition Scale (SIS/SES) and Beck’s Depression Inventory (BDI). No evidence of an effect on expectations on changes in IIEF or BDI scores could be identified. Although changes in IIEF, and BDI scores from recruitment to three months were indicative of improved sexual function and less depression, scores for most items on the expectations scale decreased, suggesting that expectations were not being met. The items for which scores decreased were the expectation to be prescribed a drug, that the drug would restore the sexual function to normal, would work within 30 minutes of administration, improve patients confidence to engage in sexual activity, and that the medication was the best treatment for ED across the three data collection points. The findings of this study indicate that improvements in erectile function did not translate into changes in medication expectations that suggested user satisfaction.
Highlights
Phosphodiesterase Type 5 Inhibitors (PDE5Is) are an established first line treatment for erectile dysfunction (ED)
Expectations did not predict the response to therapy, the significant changes in expectations that were identified suggest the need for better patient management and counselling
Erectile function improved with PDE5I use, agreement with statement that men understood how to use the drug remained low throughout the study
Summary
Phosphodiesterase Type 5 Inhibitors (PDE5Is) are an established first line treatment for erectile dysfunction (ED). Evidence supporting the importance of expectations in shaping the response to medication comes from studies that have examined the placebo effect. The decision to discontinue use can be explained by the disconfirmation theory, which states that consumers compare their pre-use expectations of products, including medications, with subsequent perceived performance [15,16]. High expectations may result in a perceived lack of efficacy which underpins the decision of the patient to discontinue use of the medication [21]. This may be relevant to PDE5Is, as most patients have high, often unrealistic, expectations of the benefits of the medications [22]
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