Use Of Erectile Dysfunction Treatments Research Articles

An Analysis of a Commercial Database on the Use of Erectile Dysfunction Treatments for Men With Employer-Sponsored Health Insurance

ObjectiveTo investigate the annual erectile dysfunction (ED) prevalence among men enrolled in an employer-sponsored health insurance (ESHI) plan and evaluate ED treatment profiles among those with an ED diagnosis. MethodsA cross-sectional claims analysis was conducted using the IBM MarketScan Commercial Database, a nationally representative sample of US workers enrolled in ESHI plans. Patients aged 18-64 with at least one ED medical diagnosis claim and continuous enrollment in a given year between 2009 and 2017 were included. Among those with an ED diagnosis, utilization rates of the following ED treatments were determined: phosphodiesterase type 5 inhibitors (PDE5I), penile prosthesis implantation, other ED treatments (eg, vacuum pump, intraurethral suppositories), combination treatment, and no insurer-paid treatments. ResultsBetween 2009 and 2017, the annual prevalence of men with ESHI suffering from ED increased by 116%. However, in 2017, only 23% of men with an ED diagnosis received an ED therapy paid for by their ESHI plans. The proportion of men taking PDE5Is ranged from 18% in 2012 to 26% in 2015. The proportion of men with ED undergoing penile prosthesis implantation has declined in recent years (0.23% in 2009 to 0.11% in 2017). Similarly, the rate of men who received other ED treatments or combination treatment has decreased from 2009 to 2017 (0.94%-0.30% and 0.65%-0.19%, respectively). ConclusionED prevalence among men insured by an ESHI plan has notably increased, yet approximately three-quarters of these men had no claims for ED treatments, indicating substantial access gaps to treatment.

A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners.

The diagnosis and treatment of prostate cancer is followed by substantive sexual morbidity. The optimal approach for intervening remains unclear. A three-arm randomised control trial was undertaken with 189 heterosexual couples where the man had been diagnosed with prostate cancer and treated surgically. The efficacy of peer-delivered telephone support versus nurse-delivered telephone counselling versus usual care in improving both men's and women's sexual adjustment was investigated. Assessments were undertaken at baseline (pre-test) with follow-up at 3, 6 and 12 months. At 12 months, men in the peer (p = 0.016) and nurse intervention (p = 0.008) were more likely to use medical treatments for erectile dysfunction (ED) than men in the usual care arm. Men in the nurse intervention more frequently used oral medication for ED than men in usual care (p = 0.002). No significant effects were found for sexual function, sexuality needs, sexual self-confidence, masculine self-esteem, marital satisfaction or intimacy. Although peer and nurse couples-based interventions can increase use of medical treatments for ED, this may not translate into better sexual or relationship outcomes. More research is needed into the optimal timing of interventions to improve sexual outcomes for men with prostate cancer and to identify the subpopulations that will benefit from them.

A biopsychosocial approach to sexual recovery after prostate cancer treatment: Suggestions for oncology nursing practice

In the past decade there has been a surge of literature documenting the impact of prostate cancer (PCa) treatment-induced erectile dysfunction (ED) on intimate relationships. While there have been significant advances in the treatment of ED, with phosphodiesterase inhibitors, vacuum erection devices and intracavernous injections, patients and their partners continue to struggle to finds ways to maintain enjoyable sexual activity. Only half of PCa patients are willing to try ED treatments, and less than half of those patients, who find ED treatments helpful in improving erectile function, will continue to use them long-term. While there are effective strategies that can be taught to patients for overcoming the barriers associated with the use of ED treatments, many patients struggle on their own with these challenges, become discouraged, and quickly give up. Nurses play a large role in patient education and counselling, both in preparing patients for PCa treatment, and in follow-up. Consequently, they are well positioned to play a significant part in promoting sexual recovery among PCa patients and, thus, increasing patients’ and partners’ experiences of success. Nurses are well versed in providing holistic biopsychosocial care, which is a much-needed approach to complement the use of biomedical ED treatments. We begin by providing suggestions for nurses to increase their competence in discussing, assessing and intervening in the area of sexual difficulties. We follow with specific suggestions, based on the PCa literature, to guide nurses in supporting patients receiving ED treatment. Guidance is offered regarding approaches to patient education that fosters the development of realistic treatment expectations. Not only should these suggestions help improve adherence to ED treatments, but they should also help patients think more broadly about the sexual recovery process, encouraging the development of goals in sexual recovery beyond restoration of erectile function. Flexibility in sexual practice is found to be a key in successful sexual renegotiation, therefore, non-penetrative sexual strategies—that are not dependent on erections—should be offered to patients, as a routine part of clinical practice. Additional suggestions regarding couple communication, persistence in the treatment process, and working through grief associated with sexual losses are also offered in addition to strategies for overcoming specific barriers such as loss of libido and demoralization associated with treatment failures. Key words: prostate cancer, erectile dysfunction, sexual adaptation, counselling, patient education

Communication and Intimacy-Enhancing Interventions for Men Diagnosed with Prostate Cancer and Their Partners

The sexual dysfunction following prostate cancer treatments often leads to a reduction in intimate contact for couples. A number of psychosocial interventions have been developed to enhance intimacy in these couples. This paper reviews three of these interventions and is a summary of a presentation given as part of a symposium at the 2011 Cancer Survivorship and Sexual Health Meeting. The goal of this presentation was to: (i) review three types of psychosocial interventions; and (ii) describe the methodological issues highlighted by these interventions. Validated measures of relationship intimacy and communication. To be selected, the interventions had to be: a randomized control trial, focus on a couples approach to therapy, and report at least one relationship outcome. The results were not consistent within or across studies, and suggest that some specific aspects of the interventions may be helpful for the patient, while other aspects of the studies may be helpful for the partner. The Northouse et al. study suggests that partners may benefit from a focus on couple work, as compared to the patient. The Canada et al. study indicates that when focusing on sexual functioning, working with a couple did not show significant benefit compared to working with a man alone. The study did show, however, that a sexual-based intervention can improve the use of erectile dysfunction treatments and suggests patients may benefit from specific focus on side effects of treatment. The Manne et al. study highlights the importance of targeting these interventions to couples who report distress, and for distressed couples, an intervention can show positive results. Intimacy enhancing interventions can be effective for couples, while the partners may benefit more from couples work; the patients may benefit more from focus on specific side effects.

Sexually Transmitted Diseases Among Users of Erectile Dysfunction Drugs

Pharmacologic treatments for erectile dysfunction (ED) have gained widespread popularity among middle-aged and older males in recent years. Driven largely by the high prevalence of erectile difficulties in this population1–8, rates of sildenafil use reportedly reached 1.4% in the commercially insured population by 2002.9 This is perhaps not surprising, since nearly 40% of men aged 57 to 85 have some degree of erectile dysfunction.8 While their clinical efficacy has been well documented, little is known about the relationship between ED treatments and the prevalence of sexually transmitted diseases (STDs). In light of growing evidence for rising STD cases, including AIDS cases, at older ages10–14, ED drugs have received attention for their possible contribution to these trends.13, 14 In fact, a recent study found that widowhood in older men, but not older women, was associated with higher rates of STDs, especially after the introduction of sildenafil (Viagra) in 1998.15 Although middle-aged and older adults generally take fewer risks with their health, their decreased need for contraception may imply less than optimal safe sexual practices compared to younger populations.16 For example, prior research suggests that condom use declines with age16, 17 and, among at-risk populations, individuals older than 50 years are one sixth as likely to use condoms during sex and one-fifth as likely to have been tested for HIV compared to individuals in their twenties.18 Moreover, a survey of primary care physicians revealed that most physicians rarely or never discuss sexual risk factor reduction with their middle-age and older patients.19 These facts are particularly important in light of the emergence of ED drugs, which have improved sexual function among older adult males. Several small studies in the MSM (men who have sex with men) community have investigated the connection between pharmacologic ED treatments and STDs.20–24 In this community, ED drug use is associated with high-risk sexual behavior, such as unprotected anal sex.20–22 ED drug users also report a greater number of recent sex partners and higher rates of STDs than non-users.21–23 While the measured outcomes of these studies likely reflect selection bias among users rather than the effect of ED drugs per se, these studies nonetheless highlight a group of individuals within the MSM community who are at high risk of contracting STDs. In light of these findings and the growing use of pharmacologic treatments for ED, we investigated the relationship between STDs and ED drug use in a comprehensive, large sample of privately insured, middle-age and older adult male beneficiaries. Large datasets are required to examine STD patterns since in the general population itself, STDs are still quite rare, and even more so among middle-age and older adults.15 For men above 40, we compared STD rates between users and non-users of ED drugs, adjusting for pre-existing STDs and other co-morbidities. We also compared STD rates within users before and after initiation of an ED drug. We hypothesized that users of ED drugs would have higher rates of STDs compared to non-users and that users of ED drugs would have higher rates of STDs in the months after initiating an ED drug compared to the months prior. A confirmation of this hypothesis would suggest two things. At a minimum, men requesting ED drugs would be at higher risk of contracting or already having sexually transmitted disease and may therefore benefit from closer monitoring of risky sexual behavior and renewed discussions about safe sexual practices. Second, the availability of ED drugs could in theory directly lead to higher rates of STDs by facilitating sexual activity among those previously less sexually active.

Sexually Transmitted Diseases Among Users of Erectile Dysfunction Drugs: Analysis of Claims Data

Pharmacologic treatments for erectile dysfunction (ED) have gained popularity among middle-aged and older men. Increased sexual activity among those who use these drugs raises concerns about sexually transmitted diseases (STDs). To examine the rates of STDs in men who use and do not use ED drugs. Retrospective cohort study. Database of claims from 1997 to 2006 for 1,410,806 men older than age 40 years with private, employer-based insurance from 44 large companies. 33,968 men with at least 1 filled prescription for an ED drug and 1,376,838 patients with no prescription. STD prevalence among users and nonusers of ED drugs. Users of ED drugs had higher rates of STDs than nonusers the year before initiating ED drug therapy (214 vs. 106 annually per 100,000 persons; P = 0.003) and the year after (105 vs. 65; P = 0.004). After adjustment for age and other comorbid conditions, users of ED drugs had an odds ratio (OR) for an STD of 2.80 (95% CI, 2.10 to 3.75) in the year before initiating drug therapy; the OR was 2.65 (CI, 1.84 to 3.81) in the year after. These differences were largely due to infections with HIV. The OR for HIV infection was 3.32 (CI, 2.38 to 4.36) in the year before and 3.19 (CI, 2.11 to 4.83) in the year after an ED drug prescription was filled. Significant changes in STD rates from the year before to the year after the first ED drug prescription was filled were not documented (adjusted OR for STD for users before vs. after the first ED drug prescription was filled, 0.96 [CI, 0.87 to 1.06]). Selection bias precludes conclusions about whether use of ED treatments directly leads to increases in STDs. Men who use ED drugs have higher rates of STDs, particularly HIV infection, both in the year before and after use of these drugs. The observed association between ED drug use and STDs may have more to do with the types of patients using ED drugs rather than a direct effect of ED drug availability on STD rates. Counseling about safe sexual practices and screening for STDs should accompany the prescription of ED drugs. RAND Roybal Center, National Institutes of Health, and Agency for Healthcare Research and Quality.

Prophylaxis of Erectile Function After Radical Prostatectomy with Phosphodiesterase Type 5 Inhibitors

Erectile dysfunction (ED) is one of the most challenging complications associated with radical prostatectomy (RP) for clinically localized prostate cancer. Currently, a broad spectrum of therapeutic options are available to improve sexual health after surgical treatment. Several basic science reports highlighted a potential role for phosphodiesterase type 5 inhibitors in the prevention of endothelial damage related to ischemia reperfusion and/or denervation following surgery. Recent studies have shown that pharmacological prophylaxis soon after RP can significantly improve the rate at which erectile function is recovered after surgery. Use of on-demand treatments for ED in patients who have undergone RP has been shown to be highly effective. In this context, pharmacological prophylaxis potentially may have a significantly expanded role in future strategies aimed at preserving postoperative erectile function. We analyzed the factors affecting erectile function after RP and evaluated the evidence suggesting the role of pharmacological prophylaxis and treatment of ED after surgery.

Bad Bedfellows: Disability Sex Rights and Viagra

The disability rights movement grounds material critiques of the treatment of people with disabilities in a social constructionist perspective, locating disability in the social rather than physical realm, and demedicalizing the concept of disability. However, this conceptualization is threatened by the medicalization of nonnormative erections as the biomedical pathology erectile dysfunction (ED). Although use of medical treatments for ED can have positive outcomes for individuals, the medical community's tendency to include sexual difference in the rubric of disability threatens to remedicalize that category. Furthermore, medicalized conceptions of ED often serve to refocus sexuality around phallocentric, normative sex acts and gender roles, undoing the deconstructive work of disability sex studies. Finally, although aging Western populations targeted for ED treatment represent potentially expanded bases for disability movement activism, the pathologizing of nonnormative sexuality may have the power to instead focus this group on individualistic use of medical interventions geared toward “normalcy.”

TREATMENT OF ERECTILE DYSFUNCTION FOLLOWING THERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER: PATIENT REPORTED USE AND OUTCOMES FROM THE SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS PROSTATE CANCER OUTCOMES STUDY

Erectile dysfunction (ED) persists for years following curative therapies for clinically localized prostate cancer. We report use and treatment outcomes in a 5-year interval in a population based cohort from the Surveillance, Epidemiology, and End Results Prostate Cancer Outcomes Study. A sample of 1,977 men with localized prostate cancer who received external beam radiation therapy or radical prostatectomy in 1994 to 1995 were surveyed for 5 outcome measures of ED treatment, namely treatment, perceived helpfulness, erectile sufficiency, sexual activity frequency and erection maintenance. Subjects were surveyed 6, 12, 24 and 60 months after prostate cancer diagnosis. Overall 50.5% of men ever used ED treatment. The use of ED treatments increased during the study course. Subject age, regular sexual partner and baseline sexual activity were factors positively associated with ED treatments. While it was used uncommonly (1.9%), a penile prosthesis was perceived as the most helpful ED treatment (helped a lot in 52% of respondents). Sildenafil helped a lot in 12% of respondents. Erectile fullness, erection maintenance and sexual activity frequency were modestly improved in men using ED treatment compared with those in men not using ED treatment. Approximately half of the patients in this population based cohort of men used ED treatment during the 5 years following prostate cancer diagnosis. Men using ED treatments had modest improvement in sexual function compared with men that in who did not receive ED treatment at 60 months. More effective treatments for ED following local therapy for prostate cancer are needed.

The use of treatments for erectile dysfunction among survivors of prostate carcinoma

The objectives of this survey were to describe the prevalence of using a treatment for erectile dysfunction (ED) among men after therapy for localized prostate carcinoma and to construct models explaining the variance in trying a treatment, treatment success, and adherence to treatment. A postal survey was sent to 2636 men in The Cleveland Clinic Foundation's Prostate Cancer Registry who were treated initially with either definitive radiotherapy or prostatectomy for localized prostate carcinoma. The survey asked about demographic items, past and current sexual functioning, and the partner's sexual function. Men were asked about their current and intended use of medical treatments for ED. Standardized questionnaires included the Sexual Self-Schema Scale-Male Version, the International Index of Erectile Function, urinary and bowel symptom scales from the Los Angeles Prostate Cancer Index), and the Short-Form Health Survey. The return rate was 49%. Differences between men who returned the questionnaire and men who did not respond suggest that the sample was weighted toward men who were more interested in staying active sexually. ED was a problem for 85% of men, and 59% of this group used at least 1 treatment for ED. Only 38% of men found that a medical treatment was at least somewhat helpful in improving their sex lives, however, and 30% of respondents still were using at least 1 treatment at the time of the survey. Factors that were associated with the efficacy of treatments for ED and with their continued use included having a sexual partner, younger age, choosing a treatment for prostate carcinoma that was more likely to spare some sexual function, and not having had neoadjuvant or current antiandrogen therapy. Men who tried a greater number of treatments for ED were more likely to find one that worked. Men were more likely to continue using treatments for ED that produced greater improvements in sexual function. The success of medical treatments for men with ED among long-term survivors of prostate carcinoma is limited. Men prefer noninvasive treatments, although invasive treatments are more effective. Sexual counseling for men and their partners is recommended, because it may increase the use of medical therapies for ED. Creating more realistic expectations in both partners also may enhance treatment adherence.